The Maryland Pharmacist 52:no. 1-12 (1976)

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THE
MARYLAND
PHARMACIST

Official Journal of
The Maryland
Pharmaceutical
Association

JAN/FEB/MAR 1976
VOL 52
NO 1-2-3

Pharmacists for the Future

Change or Perish.
An Editorial

The Report of the Study

Commission on Pharmacy
The Millis Report

Institutional Pharmacy Data
For All Pharmacists

THE LILLY DIGEST PRELIMINARY REPORT

Community Pharmacy .. . 1975

An Analysis of 852 community pharmacy operations submit-
ting 1975 data for the preliminary Lilly Digest report shows a
continuum of increases for most items on the income and
expense statement. The perpetual questions facing community
pharmacists are those of isolating increases in the expense
figures for possible reduction and of determining methods for
stimulating income. When the preliminary data, expressed as
percentages of total sales, are compared with 1974 Lilly Digest
figures, they indicate that...

The cost of goods sold was higher and total expenses re-
peated a slight decline this year, but the balance tipped in
favor of a decline in net profit before taxes, to a level of 3.6
percent of sales.

Total sales achieved new highs, with a record $293,763, an
increase of $21,423 (7.87 percent) over 1974 sales. This
growth rate compares favorably with the annual growth
rate of 5.4 percent over the past decade. Prescription sales
again out-performed other sales by posting a 8.64 percent
gain as compared with 7.15 percent for other sales, but both
areas advanced at a greater pace than in the previous year.
During 1975, prescription sales, as a percentage of total
sales, achieved a 48.2 percent level, up from 47.9 percent in
1974. The growth and increasing predominance of prescrip-
tion sales, in relation to other sales, further illustrates the
reliance on the prescription department by the average
community pharmacy.

With the rise in cost of goods sold (larger percentagewise
than the growth in total sales), the gross margin fell to 35.6
percent of sales, which represents the lowest level since
1959;

Total operating expenses went up by $6,519 (7.46 percent),
but, as a percentage of sales, they dropped slightly, to 32.0
percent. Employees’ wages also increased dollarwise, but
this expense category declined again to a level of 11.4
percent of sales in 1975. The average proprietor’s salary
increased $1,191 (5.34 percent), but total income (salary
plus net profit, before taxes) fell from the 1974 figure of 11.9
percent of sales to 11.6 percent.

The inventory level rose in total dollars but decreased
slightly as a percentage of sales. The sales productivity of
the prescription department inventory reached a new high
of $8.33 per stock dollar (1.17 percent increase), and other
merchandise produced $4.73 per dollar invested in inven-
tory (1.1 percent gain).

New prescriptions continued to achieve a larger share of
the total number of prescriptions filled. They accounted for
47.2 percent of all prescriptions dispensed (up from 46.3

percent in 1974), which provided a growth of 4.65 percent.
Total prescriptions dispensed increased by 768, to an an-
nual figure of 27,857. This new level of prescription activity
amounted to a 2.84 percent gain over the 1974 value. The
average prescription charge went up 27 cents during 1975,
from $4.81 to $5.08 — up 5.6 percent.

New Clinical Pharmacy
Reference Published

A compilation of reports on clinical pharmacy practice which
have appeared in the American Journal of Hospital Pharmacy are |
now assembled in the Clinical Pharmacy Sourcebook. The 400-
page Sourcebook was prepared by ASHP in cooperation with
Publishing Sciences Group. The selected articles cover the fol- |
lowing topics: the past, present and future of clinical pharmacy; |
implementation, administration and evaluation of clinical ser-
vices; clinical pharmacy services for hospitalized and ambula-
tory patients; therapeutic considerations; and biopharmaceu-—
tics and pharmacokinetics. The book also includes a bibliog-
raphy of additional readings and a detailed index.

The Clinical Pharmacy Sourcebook will be useful to anyone |
who has an interest in reviewing a selective sample of the
literature on clinical pharmacy practice. Copies are available for —
$20 each from Publishing Sciences Group, Inc., 162 Great Road,
Acton, MA 01720. |

CPSC Surveys Pharmacy Compliance ~—
With Packaging Requirement

The Consumer Product Safety Commission (CPSC) is con- |
ducting a survey of consumers in order to determine the degree
of compliance by pharmacists with the child-resistant packaging
regulation for oral prescription drugs. The door-to-door survey |
of a representative national sample of households is expected
to provide information about the names of pharmacies which
are not complying with the requirement and the extent of the
problem. The CPSC also hopes that the publicity generated by |
the program will encourage greater compliance by pharmacies.
An incidental aspect of the survey will be improved consumer |
knowledge of the regulation and the reasoning behind it.

The survey was stimulated by the fact that accidental inges- |
tion of oral prescription drugs by children less than five years
old has continued, even after the implementation of the CPSC |
regulation.

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ediatric Drops

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ANUARY - FEBRUARY - MARCH, 1976

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THE MARYLAND PHARMACIST

650 WEST LOMBARD STREET
BALTIMORE MARYLAND 21201
TELEPHONE 301/727-0746

JAN/FEB/MAR, 1976 VOL. 52 NO. 1-2-3
CONTENTS

Lilly Digest Preliminary Report

Editorial — Pharmacists for the Future — Change or Perish

ad
6
6 Calendar
8

Pharmacists for the Future — The Report of the Study
Commission on Pharmacy — Dr. John S. Millis

16 Institutional Pharmacy — Excerpts from the University of
Maryland Hospital Pharmacy and Therapeutics Bulletin

24 Maryland Board of Pharmacy — Pharmacy Changes

25 Aspirin After Three Quarters of a Century —
lOhnnee@ekrantzZ, Jrs.PhzD.

26 Baltimore Metropolitan Pharmaceutical Association
60th Annual Banquet

29 Second USP — NF Supplement
33. Tuberculosis in Baltimore

34 Obituaries

ADVERTISERS
36 Abbott 4 Loewy Drug Company
28 Burroughs Wellcome 32 Maryland News
15 Calvert Drug Company 7 Mayer & Steinberg, Inc.
24 District Photo Service 27 Norcliff Thayer
9-10 Geigy Pharmaceuticals 35 Paramount Photo Service
18-19 The Henry B. Gilpin Company 12-13. Pharmaceutical Manufacturer’s

Association
22-23 Lederle Laboratories eas

30-31 Roche Laboratori
3 Eli Lilly & Co., Inc. oche Laboratories

Change of address may be made by sending old address (as it appears on your journal) and new address
with zip code number. Allow four weeks for changeover. APhA members — please include APhA number.

The Maryland Pharmacist is published monthly, except for January, February, and March, 1976, combined,
by the Maryland Pharmaceutical Association, 650 West Lombard Street, Baltimore, Maryland 21201. Sub-
scription price is $5.00 a year. Entered as second class matter December 10, 1925, at the Post Office at
Baltimore, Maryland, under the Act of March 8, 1879.

JANUARY - FEBRUARY - MARCH, 1976

NATHAN |. GRUZ, Editor

PETER P. LAMY, PhD.,

Institutional Pharmacy Editor

ROSS P. CAMPBELL, News Correspondent
HERMAN BLOOM, Photographer
OFFICERS & BOARD OF TRUSTEES
1975-76

Honorary President

FRANK BLOCK

President

HENRY G. SEIDMAN—Baltimore
President Elect

MELVIN N. RUBIN—Arbutus

Vice President

RICHARD D. PARKER—Kensington
Treasurer

MORRIS LINDENBAUM

5 Main St., Reisterstown, Md. 21136
Executive Director

NATHAN I. GRUZ

650 W. Lombard St., Baltimore, Md. 21201

TRUSTEES

PAUL FREIMAN, Chairman
Baltimore

LEONARD J. DeMINO (1978)
Wheaton

S. BEN FRIEDMAN (1976)
Potomac

ROBERT J. MARTIN (1977)
LaVale

ROBERT E. SNYDER (1978)
Baltimore

JAMES W. TRUITT, JR. (1976)
Federalsburg

RUDOLPH F. WINTERNITZ
Silver Spring

(Resigned March 4, 1976)
STANLEY J. YAFFE (1977)
Odenton

EX-OFFICIO MEMBER
WILLIAM J. KINNARD, JR.—Baltimore

HOUSE OF DELEGATES

Speaker

IRVIN KAMENETZ— Owings Mills
Vice Speaker

SAMUEL LICHTER—Randallstown

Secretary
NATHAN |. GRUZ—Baltimore

MARYLAND BOARD OF PHARMACY

President

MORRIS R. YAFFE—Potomac
CHARLES H. TREGOE—Parkton

I. EARL KERPELMAN—Salisbury
RALPH T. QUARLES, SR.—Baltimore

Secretary
ROBERT E. SNYDER—Baltimore

editorial

PHARMACISTS FOR THE FUTURE — CHANGE OR PERISH

The world of pharmacy has been presented with the ‘Millis
Report”? — the first comprehensive study of the practice of
pharmacy and the process of pharmacy education since the 1950
“Elliott Survey’’?. This report addresses itself to the com-
plexities of contemporary pharmacy, attempts to discern the
patterns of future development and recommends a series of
actions beginning with revisions in the educational foundations
which will benefit the profession and result in enhanced health
to all through improved drug related services to society.

The ‘Millis’ report not only deserves reading, it is in our
opinion required reading for anyone in or out of pharmacy who
would have any pretensions to being informed about phar-
macy, who wishes to be more effective in his role as a health
professional, or who has any pretensions to leadership in the
profession of pharmacy.

The profession of pharmacy in Maryland can be proud that

the representative of community pharmacy on the study com-
mission was Victor H. Morgenroth, Jr., a past president of the

Maryland Pharmaceutical Association.

We have printed elsewhere in this issue the highlights of the
report presented by Dr. John S. Mills, its chairman. Here we
shall only focus briefly on just a few of the concepts, findings
and recommendations.

¢ A major deficiency in the health care system is the unavail-
ability of adequate information for patients, prescribers, dis-
pensers and administrators of drugs. Result: inappropriate drug
use and frequent drug-induced disease. Pharmacists could
meet this need for both consumers and health professionals.
Education and training of pharmacists must be tailored to meet
this informational role.

© Pharmacy is advanced conceptually as aknowledge system

that provides a service, translating part of the data into drug
products which it distributes.

® Educational objectives for pharmacy education are out-
lined, but above all the necessity for a curriculum based upon
competencies is pointed out.

* Attention is given to the need for greater emphasis on the
behavioral and social sciences in the curriculum.

* Most important, the thrust of the Millis Report is that there
is awhole universe of health care service — drug therapy — that
is not being adequately, properly or effectively provided. The
pharmacist is the individual who with appropriately modified
educational preparation is the health professional who can best
meet the unmet needs for rational, effective use of medication.

6

The prevention and treatment of disease and the maintenance -
of health rests in substantial part upon the contributions that —

pharmacists should make in the drug aspect of the delivery of
health care.

This, then, is the lesson to be learned from reading the “Millis

Report’’ — Pharmacists for the Future. It can be ignored by —
pharmacists only at the peril of their professional and economic |
survival. It can be ignored by other health professionals only at _
the neglect of their specific responsibilities to patients and .

public health. It is hard to believe that the implications of the

report will be ignored indefinitely by informed members of the

public and their representatives in government.

Thus, the responsibility for initiating and implementing the -
required changes in ‘‘pharmacy” will either be assumed by —

pharmacists and their organizations or others surely must and

will inevitably take the steps necessary to meet the challenge so _

incisively stated in the “Millis Report.”

What part will each of you play in this drama?
— Nathan |. Gruz, R.Ph.

' The American Association of Colleges of Pharmacy, Pharmacists For

The Future: The Report of the Study Commission on Pharmacy. Health -

Administration Press, Ann Arbor, MI., 1975.

? Elliott, Edward C., Director, The General Report of the Pharmaceutical |

Survey, 1946-1949, American Council for Education, Washington, D.C.,
1950.

calendar

September 9 (Thursday) — MSHP Meeting, Johns
Hopkins Hospital

September 19-23 — NARD Convention, San
Francisco

November 4 (Thursday) — MPhA Simon Solomon
Pharmacy Economics Seminar

THE MARYLAND PHARMACIST

i

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PHARMACISTS FOR THE FUTURE

The Report of the Study
Commission on Pharmacy —
The Millis Commission

Principal Concepts, Findings and Recommendations
Dr. John S. Millis, Commission Chairman

Pharmacy

The Commission believes that pharmacy should be con-
ceived as aknowledge system which renders a health service by
concerning itself with understanding drugs and their effects
upon people and animals. Pharmacy generates knowledge
about drugs, acquires relevant knowledge from biological,
chemical, physical, and behavioral sciences; it tests, organizes,
and applies that knowledge. Pharmacy translates a substantial
portion of that knowledge into drug products and distributes
them widely to those who require them. Pharmacy knowledge
is disseminated to physicians, pharmacists, and other health
professionals and to the general public to the end that drug
knowledge and its consequent products may contribute to the
health of individuals and the welfare of society.

Pharmacy has usually been conceived as a product system.
Important as drug products are, in our judgment knowledge
about those products and those people who consume them is
even more important. Hence we view pharmacy as a whole as a
knowledge system — not a product system.

The Study Commission on Pharmacy was formed at the re-
quest of the American Association of Colleges of Pharmacy after
careful study and planning by acommittee under the leadership
of Dr. Arthur Schwarting, former president of the Association
and dean of the School of Pharmacy at the University of Con-
necticut. The Commission’s work was supported by generous
grants from the American Foundation for Pharmaceutical Edu-
cation, the W. K. Kellogg Foundation, the Commonwealth
Fund, the Edna McConnell Clark Foundation, and the Robert
Wood Johnson Foundation.

The membership was composed of twelve persons with ex-
tensive experience and knowledge in the fields of pharmaceuti-
cal manufacturing, pharmaceutical research, pharmacy prac-

8

tice, pharmacy education, medicine, nursing, behavioral sci-
ence, and higher education. Unhappily, the contributions of
Mr. Henry DeBoest were lost because of his untimely death in
December 1973. The assigned task as seen by the Commission
was to acquire data, to gather informed opinion, to think, and to
make rational and practical suggestions for the improvement in
the education of the pharmacists for the future — all of this to
the end that more excellent drug-related health services can be
provided to the citizens of our nation.

Fortunately, data sufficient to our needs were readily avail-
able. We had the privilege of receiving the informed opinions,
the advice and suggestions of more than eighty leaders from
pharmacy practice, pharmacy education, medicine, nursing,
hospital administration, pharmaceutical research, pharmaceut-
ical manufacturing, professional pharmacy organizations, and
government at both the federal and state level. We are deeply
grateful to those men and women who took the time to share
their knowledge and experience with us.

The most important part of the Commission's responsibility
was to think and to learn. That frequently difficult task was
accomplished by the Commission working throughout two
years as a committee-of-the-whole — digesting data, evaluating
opinions, developing concepts, formulating conclusions. Some
will claim that there is no such thing as group thinking. My
experience and observation of the operation of the Study
Commission on Pharmacy has convinced me that the assertion
is wrong. As chairman, | wish to report that | have had the
privilege of working with a group of distinguished, thoughtful,
and devoted people who have given freely of their time and
effort to this enterprise. Pharmacy and pharmacy education
should be eternally grateful to them.

(Continued on Page 11)

THE MARYLAND PHARMACIST

Tofranil-PM” Say
imipramine

In depression

Daily Dosage Chart

Tofranil-PM°

imipramine pamoate

One capsule
lasts from bedtime
to bedtime.

Initial Dose

For Maintenance Therapy

Usual Optimum
Response Dose

Starting
Dose

A Full Range to Choose From*

J UE

150 WS) 100 io

mg. mg. mg. mg.

“Each capsule contains imipramine pamoate
equivalent to 150, 125, 100 or 75 mg. imipramine
hydrochloride.

Tofranil-PM®
brand of imipramine pamoate

Indications: For the relief of symptoms of depression.
Endogenous depression is more likely to be alleviated
than other depressive states

Contraindications: The concomitant use of monoamine

oxidase inhibiting compounds is contraindicated. Hyper-

pyretic crises or severe convulsive seizures may occur in
patients receiving such combinations. The potentiation of
adverse effects can be serious, or even fatal. When it is
desired to substitute Tofranil-PM, brand of imipramine
pamoate, in patients receiving a monoamine oxidase in-
hibitor, as long an interval should elapse as the clinical
situation will allow, with a minimum of 14 days. Initial
dosage should be low and increases should be gradual
and cautiously prescribed. The drug is contraindicated
during the acute recovery period after a myocardial infarc-
tion. Patients with a known hypersensitivity to this com-
pound should not be given the drug. The possibility of
cross-sensitivity to other dibenzazepine compounds
should be kept in mind.

Warnings: Usage in Pregnancy: Safe use of imipramine

during pregnancy and lactation has not been established:

therefore, in administering the drug to pregnant patients,
nursing mothers, or women of childbearing potential, the
potential benefits must be weighed against the possible
hazards. Animal reproduction studies have yielded incon-
clusive results. There have been clinical reports of con-
genital malformation associated with the use of this drug,
but a causal relationship has not been confirmed.

Extreme caution should be used when this drug is given

to

—Ppatients with cardiovascular disease because of the
possibility of conduction defects, arrhythmias, myocar-
dial infarction, strokes and tachycardia;

— patients with increased intraocular pressure, history of
urinary retention, or history of narrow-angle glaucoma
because of the drug's anticholinergic properties;

—hyperthyroid patients or those on thyroid medication
because of the possibility of cardiovascular toxicity;

—patients with a history of seizure disorder because this
drug has been shown to lower the seizure threshold;

—patients receiving guanethidine or similar agents since
Imipramine may block the pharmacologic effects of
these drugs

Since imipramine may impair the mental and/or physical

abilities required for the performance of potentially

hazardous tasks such as operating an automobile or
machinery, the patient should be cautioned accordingly

Usage in Children: Tofranil-PM, brand of imipramine

pamoate, should not be used in children of any age be-

cause of the increased potential for acute overdosage
due to the high unit potency (75 mg., 100 mg., 125 mg
and 150 mg.). Each capsule contains imipramine

pamoate equivalent to 75 mg., 100 mg., 125 mg. or 150

mg. imipramine hydrochloride

Precautions: |t should be kept in mind that the possibility

of suicide in seriously depressed patients is inherent in
the illness and may persist until significant remission oc-
curs. Such patients should be carefully supervised during
the early phase of treatment with Tofranil-PM, brand of
imipramine pamoate, and may require hospitalization.
Prescriptions should be written for the smallest amount
feasible.

Hypomanic or manic episodes may occur, particularly in
patients with cyclic disorders. Such reactions may neces-
sitate discontinuation of the drug. If needed, Tofranil-PM,
brand of imipramine pamoate, may be resumed in lower
dosage when these episodes are relieved. Administration
of a tranquilizer may be useful in controlling such
episodes.

Prior to elective surgery, imipramine should be discon-
tinued for as long as the Clinical situation will allow.

An activation of the psychosis may occasionally be ob-
served in schizophrenic patients and may require reduc-
tion of dosage and the addition of a phenothiazine.

In occasional susceptible patients or in those receiving
anticholinergic drugs (including antiparkinsonism agents)
in addition, the atropine-like effects may become more
pronounced (e.g., paralytic ileus). Close supervision and
careful adjustment of dosage is required when this drug is
administered concomitantly with anticholinergic or sym-
pathomimetic drugs.

Avoid the use of preparations, such as decongestants
and local anesthetics, which contain any sympathomime-
tic amine (e.g., adrenalin, noradrenalin), since it has been
reported that tricyclic antidepressants can potentiate the
effects of catecholamines.

Patients should be warned that the concomitant use of
alcoholic beverages may be associated with exaggerated
effects.

Both elevation and lowering of blood sugar levels have
been reported.

Concurrent administration of imipramine with electroshock
therapy may increase the hazards; such treatment should
be limited to those patients for whom it is essential, since
there is limited clinical experience.

Adverse Reactions: Note: Although the listing which fol-
lows includes a few adverse reactions which have not
been reported with this specific drug, the pharmacological
similarities among the tricyclic antidepressant drugs re-
quire that each of the reactions be considered when imip-
ramine is administered.

Cardiovascular: Hypotension, hypertension, tachycardia,

palpitation, myocardial infarction, arrhythmias, heart block,

stroke, falls.

Psychiatric: Confusional states (especially in the elderly)
with hallucinations, disorientation, delusions; anxiety,
restlessness, agitation; insomnia and nightmares;
hypomania; exacerbation of psychosis.

Neurological: Numbness, tingling, paresthesias of ex-
tremities; incoordination, ataxia, tremors: peripheral
neuropathy; extrapyramidal symptoms; seizures, altera-
tions in EEG patterns; tinnitus.

Anticholinergic: Dry mouth, and, rarely, associated sub-
lingual adenitis; blurred vision, disturbances of accommo-
dation, mydriasis; constipation, paralytic ileus; urinary re-
tention, delayed micturition, dilation of the urinary tract.
Allergic: Skin rash, petechiae, urticaria, itching, photosen-

sitization (avoid excessive exposure to sunlight); edema
(general or of face and tongue); drug fever; cross-
sensitivity with desipramine.

Hematologic: Bone marrow depression including agran-
ulocytosis; eosinophilia; purpura; thrombocytopenia.
Leukocyte and differential counts should be performed in
any patient who develops fever and sore throat during
therapy; the drug should be discontinued if there is evi-
dence of pathological neutrophil depression.
Gastrointestinal: Nausea and vomiting, anorexia, epigas-
tric distress, diarrhea; peculiar taste, stomatitis, abdominal
cramps, black tongue.

Endocrine: Gynecomastia in the male; breast enlarge-
ment and galactorrhea in the female; increased or de-
creased libido, impotence; testicular swelling; elevation or
depression of blood sugar levels.

Other: Jaundice (simulating obstructive); altered liver
function; weight gain or loss; perspiration; flushing; uri-
nary frequency; drowsiness, dizziness, weakness and
fatigue; headache; parotid swelling; alopecia.

Withdrawal Symptoms: Though not indicative of addiction,
abrupt cessation of treatment after prolonged therapy
may produce nausea, headache and malaise.

Dosage and Administration: In adult outpatients,
therapy should be initiated on a once-a-day basis with 75
mg./day. This may be increased to 150 mg./day which is
the dose level which usually obtains optimum response. If
necessary, dosage may be increased to 200 mg./day.
Dosage should be modified as necessary by clinical re-
sponse and any evidence of intolerance. Daily dosage
may be given at bedtime, or in some patients in divided
daily doses.

Hospitalized patients should be started on a once-a-day
basis with 100-150 mg./day and may be increased to 200
mg,./day. Dosage should be increased to 250-300 mg./day
if there is no response after two weeks.

Following remission, maintenance medication may be re-
quired for a longer period of time at the lowest dose that
will maintain remission. The usual adult maintenance
dosage is 75-150 mg./day on a once-a-day basis, prefer-
ably at bedtime.

In adolescent and geriatric patients, capsules of Tofranil-
PM, brand of imipramine pamoate, may be used when
total daily dosage is established at 75 mg. or higher. It is
generally unnecessary to exceed 100 mg./day in these
patients. This dosage may be given once a day at bed-
time or, if needed, in divided daily doses.

How Supplied: Tofranil-PM, brand of imipramine
pamoate: Capsules of 75, 100, 125 and 150 mg. (Each
capsule contains imipramine pamoate equivalent to 75,
100, 125 or 150 mg. of imipramine hydrochloride.)

(B) 98-146-840-A(9/75) 667120

For complete details, including dosage and adminis-
tration, please refer to the full prescribing informa-
tion.

GEIGY Pharmaceuticals
Division of CIBA-GEIGY Corporation
Ardsley, New York 10502

SA 11472

| shall proceed to state the principal concepts, findings, and
recommendations advanced by the Study Commission which
are the core of its Report to which we have given the title —
Pharmacists for the Future.

Pharmacy — A Health Service

The Commission believes that pharmacy is a health service
and that any examination of pharmacy or any of its parts must be
made within the context of the entire health service system. The
Commission further believes that among the deficiencies in the
health care system, an important one is the unavailability of
adequate information for those who consume, prescribe, dis-
pense, and administer drugs. This deficiency has resulted in
inappropriate drug use and an unacceptable frequency of
drug-induced disease. Pharmacists are seen as health profes-
sionals who could make an important contribution to the health
care system of the future by providing information about drugs
to consumers and health professionals. Education and training
of pharmacists now and in the future must be developed to
meet these important responsibilities.

Pharmacists

We have learned that there are pharmacists practicing the

profession in every part or subsystem of pharmacy. They are
involved in generating knowledge through research, in translat-

ing knowledge into technology through development, testing
knowledge and its consequent technology in clinical trials; in
dosage formulation; in manufacture; in distribution; in dis-
pensing; in administering; in information dissemination; in
regulation; in systems management; and every other activity
that one can conceive as within the knowledge system we call
pharmacy.

The Study Commission, therefore, believes that a pharmacist
must be defined as an individual who is engaged in one of the
steps of a system called pharmacy. We cannot define a pharma-
cist simply as one who practices pharmacy. Rather, he must be
defined as one who practices a part of pharmacy which is de-
termined by the activities carried on in one of the subsystems of
pharmacy. A pharmacist is characterized by the common de-
nominator of drug knowledge and the differentiated additional
knowledge and skill required by his particular role.

A Judgment of Pharmacy

Based upon its collective knowledge and experience and
upon its recent observation the Commission feels that the sys-
tem of pharmacy must be described as being both effective and
efficient in developing, manufacturing and distributing drug
products. But it cannot be described as either effective or effi-

cient in developing, organizing, or distributing knowledge and

information about drugs. When viewed as a knowledge system,
which it is, pharmacy must by judged as only partially suc-
cessful. It has not in the past and does not now make its full
contribution to the health of the nation and of its citizens. The
Study Commission therefore recommends that major attention
be given to the problems of drug information to find out who
needs to know, what he needs to know, and how these needs
can be met with speed and economy.

Objectives of Pharmacy Education

The Commission believes that in spite of the real and multi-
faceted differentiation in the practice roles of pharmacists,

JANUARY - FEBRUARY - MARCH, 1976

there is a common body of knowledge, skills, attitudes and
behavior which all pharmacists must possess. We believe that
the objectives of pharmacy education must be stated in terms of
both the common knowledge and skill and the differentiated
and/oradditional knowledge and skill required for specific prac-
tice roles. We, therefore, state a series of limited educational
objectives which, if met in sequential order, will accomplish
both common and differentiated objectives.

We recommend the following three component objectives
for pharmacy education:
1. The mastery of the knowledge and the acquisition of the
skills which are common to all the roles of pharmacy prac-
LIGes

2. The mastery of the additional knowledge and the acquisi-
tion of the additional skill for the differentiated roles which
require additional pharmacy knowledge and experience.

3. The mastery of the additional knowledge and the acquisi-
tion of the additional skill needed for those differentiated
roles which require additional knowledge and skill other
than pharmacy.

You will note that the Study Commission does not advocate
either the “two-track”’ concept nor the ‘‘single track’’ concept
of pharmacy education. In fact the Commission rejects the
“track” concept entirely. We feel that the concept is misleading
and is based upon misconception of the nature of pharmacy. If
there is a useful analogy it is that of a tree. All of the practices of
pharmacy have common roots; they differentiate from a com-
mon body of knowledge and skill (the trunk of the tree); they
differentiate in horizontal directions, in vertical directions, and
in directions having both horizontal and vertical components as
do the branches of a tree.

The Competency-based Curriculum

The Study Commission advocates that the curricula of the
colleges of pharmacy be based upon the competencies desired
for the graduates and not upon the volume of knowledge avail-
able in the relevant basic sciences. Pharmacy is a profession.
The objective of any professional education is to equip its
graduates to practice with superior skill. The quality of that
education, in the last analysis, must be measured by the quality
of the performance of the graduates. Professionals must both
know and do. The professional is one who can and does trans-
late knowing (science) into doing (art). But the ultimate justifica-
tion of the educational process is the doing with competence.
Hence, the pharmacy curriculum must be designed to assure, as
far as possible, that pharmacy graduates can ‘‘do”’ with compe-
tence and should be structured around clearly defined and
essential competencies.

The Clinical Teacher

The Study Commission recognizes that the faculties of col-
leges of pharmacy have a most difficult task in identifying and
accurately defining the competencies which pharmacists must
have in the near and the long range future. In recent decades
very few faculty members have practiced pharmacy in any form.
Though highly competent in one or more basic science they
have little knowledge, experience, or understanding of what
practicing pharmacists do, can do, or should do. There are a
growing number of clinical teachers on the faculties, but few of

(Continued on Page 14)

1m

fe]

the weight of ethical opinion:

Few would disagree that the effective-
ness and safety of any therapeutic agent
or device must be determined through
clinical research.

But now the practice of clinical re-
search is under appraisal by Congress, the
press and the general public. Who shall
administer it? On whom are the products
to be tested? Under what circumstances?
And how shall results be evaluated and
utilized?

The Pharmaceutical Manufacturers
Association represents firms that are sig-
nificantly engaged in the discovery and
development of new medicines, medical
devices and diagnostic products. Clinical
research is essential to their efforts. Con-
sequently, PMA formulated positions
which it submitted on July 11, 1975, to
the Subcommittee on Health of the Sen-
ate Labor and Public Welfare Committee,
as its official policy recommendations.
Here are the essentials of PMA’s current
thinking in this vital area,

1. PMA supports the mandate and
mission of the National Commission for
the Protection of Human Subjects of
Biomedical and Behavioral Research and
offers to establish a special committee
composed of experts of appropriate
disciplines familiar with the industry's
research methodology to volunteer its
service to the Commission.

2..PMA supports the formation of an
independent, expert, broadly based and
representative panel to assess the current
state of drug innovation and the impact
upon it of existing laws, regulations and
procedures.

3. When FDA proposes regulations,
it should prepare and publish in the Fed-
eral Register a detailed statement assess-
ing the impact of those regulations on
drug and device innovation.

4.PMA proposes that an appropri-
ately qualified medical organization be

| encouraged to undertake a comprehen-

sive study of the optimum roles and
_ responsibilities of the sponsor and physi-
| cian when company-sponsored clinical
_ research is performed by independent

clinical investigators.

§. PMA recognizes that the physician-
investigator has, and should have, the
ultimate responsibility for deciding the
substance and form of the informed con-
sent to be obtained. However, PMA
recommends that the sponsor of the ex-
periment aid the investigator in dis-
charging this important responsibility by
providing (1) adocument detailing the
investigator's responsibilities under FDA
regulations with regard to patient consent,
and (2) a written description of the
relevant facts about the investigational.
item to be studied, in comprehensible
lay language.

©. In the case of children, the sponsor
must require that informed consent be
obtained from a legally appropriate rep-
resentative of the participant. Voluntary
consent of an older child, who may be
capable of understanding, in addition to
that of a parent, guardian or other legally
responsible person, is advisable. Safety of
the drug or device shall have been assessed
in adult populations prior to use in
children.

7.PMA endorses the general prin-
ciple that, in the case of the mentally
infirm, consent should be sought from
both an understanding subject and from
a parent or guardian, or in their absence,
another legally responsible person.

&. Pharmaceutical manufacturers
sponsoring investigations in prisons must
take all reasonable care to assure that the
facilities and personnel used in the con-
duct of the investigations are suitable for
the protection of participants, and for the
avoidance of coercion, with a respect for
basic humanitarian principles.

Q. Sponsors intending to conduct non-
therapeutic clinical trials through the
participation of employee volunteers
should expand the membership and scope
of its existing Medical Research Commit-
tee, or establish such an internal Medical
Research Committee, with responsibility
to approve the consent forms of all
volunteers, designs, protocols and the
scope of the trial: The Committee should
also bear responsibility to ensure full
compliance with all procedures intended
to protect employee volunteers’ rights.

10. Where the sponsor obtains medi-
cal information or data on individuals, it
shall be accorded the same confidential

Testing in Humans:
Who,Where & When.

status as provided in codes of ethics gov-
erning health care professionals.

U1. PMA and its member firms accept
responsibility to aid and encourage ap-
propriate follow-up of human subjects
who have received investigational prod-
ucts that cause latent toxicity in animals
or, during their use in clinical investiga-
tion, are found to cause unexpected and
serious adverse effects.

12.PMA supports the exploration
and development by its member compa-
nies of more systematic surveillance pro-
cedures for newly marketed products.

13. When a pharmaceutical manu-
facturer concludes, on the basis of early
clinical trials of a basic new agent, that a
new drug application is likely to be sub-
mitted, a proposed development plan
accompanied by a summary of existing
data, would be submitted to the FDA.
Following a review of this submission,
the FDA, and its Advisory Committee
where appropriate, would meet with the
sponsor to discuss the development plan.
No formal FDA approval should be re-
quired at this stage. Rather, the emphasis
should be on identification of potential
problems and questions for the sponsor's
further study and resolution as the pro-
gram develops. ;

The PMA believes that health profes-
sionals as well as the public at large
should be made aware of these 13 points
in its Policy on Clinical Research. For
these recommendations envisage con-
structive, cooperative action by industry,
research institutions, the health profes-
sions and government to encourage crea-
tive and workable responses to issues
involved in the clinical investigation of
new products.

(PT

Pharmaceutical Manufacturers
Association

1155 Fifteenth Street, N.W.
Washington, D. C. 20005

them are thoroughly trained in any basic science. They can and
do give anecdotal reports of new and imaginative pharmacy
services with which they have experimented. However, not
being fully trained in a relevant basic science, they are unable to
identify with precision the knowledge which is specifically rel-
evant to such practice. Pharmacy does not have more than a
handful of people who, in the system of medical education, are
identified as ‘clinical scientists.” These persons are fully-
trained clinicians and fully-trained scientists. They form the
indispensable link between knowing and doing. They can iden-
tify the competencies required and they can identify accurately
the basic science which is relevant to those competencies.

A further problem in pharmacy arises from the fact that, atthe
present moment, many of the “expanded” and novel roles of
pharmacy practice are the result of what a relatively small
number of highly motivated and imaginative pharmacists
wanted to do, felt they should do, or believed they could do in
providing improved patient care. Few of these roles have been
subject to rigorous and scientific examination and measure-
ment of outcomes. Few have been carefully analyzed for their
cost/benefit ratios. The competencies of which we speak are
those which are essential to an ever-increasing quality of drug-
related services to patients and are of such benefit that their cost
will be gladly paid by the health care system.

In response to these several considerations, the Study Com-

mission makes three recommendations:

1. That serious efforts be made by all colleges of pharmacy to
provide members of the faculties effective opportunities
to practice pharmacy in some role to the end that they may
be more conscious of the essential relationship of knowl-
edge and skill and, further, serve as role models for their
students.

2. That the research efforts of pharmacy faculty members be
directed as muchas possible to the solution of problems of
pharmacy practice.

3. That a concerted effort be made to organize and finance a
program to appropriately educate and train a small
number (c. 100) of “clinical scientists’ for pharmacy and
pharmacy education.

Behavioral Science

The Study Commission emphasizes that pharmacy is a knowl-
edge system in which chemical substances called drugs and
people called patients interact. Needed and optimally effective
drug therapy results only when drugs and those who consume
them are fully understood. We, therefore, suggest that one of
the first steps in the review of the educational program should
be weighing the relative emphasis given to the physical and
biological sciences as against the behavioral and managerial
sciences. It is our opinion that the latter disciplines are just as
basically relevant to the practice of pharmacy as are the former.
They belong therefore in the category of the required “basic
sciences,’’ notin the category of electives to be taken only if the
student wishes or has time for them.

Advanced Education

The Study Commission believes that those colleges of phar-
macy which have adequate resources in faculty, clinical learning
opportunities, research facilities, and financial support should
develop, in addition to the first professional degree, programs

14

of instruction at the graduate and advanced professional level
for the more differentiated roles of pharmacy practice. Con-
versely, the Study Commission believes that those schools
which do not have adequate resources should not attempt any
instruction beyond the first professional degree.

Educational Environment

It is the opinion of the Study Commission that the optimal
environment for pharmacy education is the university health
center for the full range of knowledge, skill, and practice can be
found there. However, the Commission does not believe that it
is practical or in the public interest to recommend that all
colleges of pharmacy must be so located. Alternative arrange-
ments, if effectively utilized, can provide an acceptable envi-
ronment for the education of students at the baccalaureate
level. We have serious reservations about such schools attempt-
ing instruction of a more sophisticated and/or more dif-
ferentiated character.

Credentialling

It is the opinion of the Study Commission that all aspects of —

credentialling pharmacists and pharmacy education would be
enhanced by the services of a national board of pharmacy.
Licensure requires examination. Licensure would be improved
with the assistance of improved testing provided by a highly
professional and skilled examining body. Relicensure may be
required in the near future; that will require examination.
Again, the effectiveness of the process will depend upon the
quality of the examining instruments. Accreditation of schools
of pharmacy would be greatly strengthened by the availability of
high quality and reliable examinations to measure student prog-
ress and achievement. Specialization is almost sure to come in
pharmacy. The certification of special competence must rely
upon dependable examining procedures. Neither pharmacy
nor the public can afford the cost of a host of examining bodies,
each with inadequate professional staff and no research capac-
ity. Therefore, the Study Commission recommends that the
appropriate professional bodies of pharmacy give prompt and
serious attention to the organization and support of a National
Board of Pharmacy Examiners.

Conclusion

It is the hope of all of us who have had the privilege of serving
as the Study Commission that you will read our Report carefully
and thoughtfully. The impact of our work will not be made by
the length of the Report nor by the elaborateness of its data.
Rather, if it does produce an elevation in the quality of phar-
macy education and thereby an improvement in the level of
health care, it will be because of the rationality and the
thoroughness of the intellectual exercise through which a
group of thoughtful men and women have gone. We believe
that the test of our conclusions and recommendations is not
that they agree with your preconceptions nor whether they will
result in a more advantageous position for the profession of
pharmacy. Rather, we believe that the test must be of the logic
of our thoughts and of the clarity with which we have seen the
ultimate goal of more effective and more efficient drug services.

Copies of the complete report, “Pharmacists for the Future”’,
are available at $6.00 each from the Health Administration Press,
School of Public Health, University of Michigan, Ann Arbor,
Michigan 48104.

THE MARYLAND PHARMACIST

MEMBERSHIP OF THE STUDY COMMISSION ON PHARMACY

John A. Biles, Ph.D. Victor Morgenroth, Jr., B.S., Pharmacy
Dean, School of Pharmacy Community Pharmacist

University of Southern California Charles F. Odegaard, Ph.D

Robert K. Chalmers, Ph.D. Vice Chairman

Professor of Clinical Pharmacy Professor of Higher Education

Associate Dean, Purdue University and President Emeritus

Leighton E. Cluff, M.D. University of Washington

Professor and Chairman Rozella M. Schlotfeldt, Ph.D.
Department of Medicine Professor of Nursing

University of Florida Frances Payne Bolton School of Nursing
Bryce Douglas, Ph.D. Case Western Reserve University

Vice President, William E. Smith, Jr., Pharm.D.
Research and Development Director, Pharmacy and Central Services
Smith Kline & French Laboratories Memorial Hospital Medical Center

Jan Koch-Weser, M.D. and

Associate Clinical Professor

Associate Professor of Pharmacology Ca eeect Gent RUAN THE
|

Harvard eae School, and

Chief of Clinical Pharamacology Unit Robert Straus, Ph.D.
Massachusetts General Hospital Professor and Chairman
John S. Millis, Ph.D., Chairman Department of Behavioral Science

College of Medicine
University of Kentucky

Chairman, National Fund for
Medical Education, and
Chancellor Emeritus Lucy H. Joutz, Secretary

Case Western Reserve University

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W.S.P. = WEEKLY SPECIALS PROGRAM
and
C.P.P. = CONTROLLED PERCENTAGE PROGRAM

PHONE: (301) 467-2780
THE CALVERT DRUG COMPANY

901 CURTAIN AVENUE
BALTIMORE, MARYLAND 21218

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JANUARY - FEBRUARY - MARCH, 1976 7

institutional
OlNeKANaCY

Excerpts from the Pharmacy
and Therapeutics Bulletin,
University of Maryland Hospital,
Institutional Pharmacy Programs,

Carolyn Love, M.S.
Drug Information Specialist, Editor.

Skin Tests for Anergy

The following is a list of skin tests for anergy and the proce-
dures for their use. All are given intradermally in the flexor
surface of the forearm.

1. Candida Skin Test (Dermatophyton-O; Hollister-Stier)

This skin test is prepared from Candida (Monilia) albicans
and is recommended for testing of delayed sensitivity. It is
available in a strength of 1:100 and generally for the test to
be positive, a dilution of no stronger than 1:100 is used.
Approximately 30 percent of patients tested will react posi-
tively. The test sites are observed 24-72 hours later for
erythema and induration. If the reaction area is 5-20 mm.
the test dilution can be used to start treatment. If the reac-
tion area is greater than 20 mm. further dilution of the
extract should be made (1:500). The dose administered is
0.1 ml. in all cases. The solution itself is stable for 12 months
if refrigerated.

2. Coccidiodin or Histoplasmin

The dose administered is 0.1 ml. and the test is read at 24,
48 and 72 hours. Both solutions are 1:100 dilutions.

3. Mumps Skin Test

This antigen is a suspension of killed mumps virus. Each
ml. of the skin test antigen contains at least 20
complement-fixing units. A dose of 0.1 ml. should be ad-
ministered and the reaction site should be read at 4 hours to
assess arthrus reactions and then, at 24-48 hours to assess
delayed hypersensitivity. Approximately 96 percent of pa-
tients will have a positive reaction (diameter of induration
and erythema of at least 5 mm.). The solution is stable for 18
months after reconstitution if refrigerated.

4. Purified Protein Derivative (Tuberculin, Parke-Davis)

This test is available in three strengths: first strength PPD
(1:10,000), intermediate strength PPD (1:2,000), and second
strength PPD (1:40). A dose of 0.1 ml. is administered and
the reaction site is read at 24, 48 and 72 hours. A positive
reaction would be erythema or induration of at least 5 mm.

5. Streptokinase-Streptodornase (Varidase, Lederle)

The intermediate strength test preparation is diluted so
that it contains 4 units of streptokinase and 1 unit of strep-

16

todornase per 0.1 ml. while the second strength solution
contains 40 units of streptokinase and 10 units of strep-
todornase per 0.1 ml. dose. Approximately 52 percent of
patients tested respond positively to the intermediate
strength whereas 95 percent of patients respond positively
to the second strength solution. The test is read in 24-72
hours and a positive reaction would be erythema or indura-
tion of at least 5 mm. The test solution is stable after recon-
stitution for 12 months if refrigerated.

. Trichophyton (Dermatophyton, Hollister-Stier)

This test is prepared from filtrates of trichophyton or-
ganisms. Diagnostically it is used in older patients to deter-
mine exposure to trichophyton fungus. Also, since many
people have been exposed to this fungus, it may be used as
a test of anergy. It is available in a strength of 1:30 and is
administered in a0.1 ml. dose. Approximately 15 percent of
patients tested react positively. Erythema and induration of
at least 5 mm. in 24-72 hours is considered a positive test.
The solution itself is stable for 12 months if refrigerated.

References

1. Product literature on each of the agents.
2. Palmerand Reed: ‘‘Delayed Hypersensitivity Skin Testing —

Response Rates in a Hospitalized Population.” J. Infect. Dis.
130 (2): 132-137 (Aug.), 1974.

. Palmer and Reed: “Delayed Hypersensitivity Skin Testing —

Clinical Correlates and Anergy.” J. Infect. Dis., 130 (2):
138-143 (Aug.), 1974.

Cautions to Travelers

. It may be wise to take the following with you on your

vacation:

a. Typed copies of regular ongoing prescriptions. The pre-
scriptions should include the trade, generic and chemi-
cal name of the drug as well as dosage. Also, a prescrip-
tion for replacement of eyeglasses may be useful.

b. Immunization records (e.g. Many physicians are reluc-
tant to give tetanus shots unless absolutely necessary).

THE MARYLAND PHARMACIST

c. Medic-Alert or other means of listing any chronic health
conditions (e.g. diabetes, heart disorders), allergies, or
a list of any medications taken regularly. This could be
useful in an accident or when you are unable to com-
municate with a physician.

d. Telephone numbers of physicians who regularly treat
you so that a new physician can get information needed
as rapidly as possible.

. Check with the U.S. Embassy in the particular country
visited and they can supply you with a list of U. S. trained
physicians practicing in the country visited. This often is
wise to assure quality health care and the physician may be
more familiar with U. S. drugs.

. Patients with chronic illnesses should carry a sufficient sup-
ply of their maintenance drugs with them (e.g. digitalis,
anticoagulants, oral contraceptives). This is necessary since
the potency and quality of many drugs differ abroad. It is
necessary, however, to be aware of the storage require-
ments of each individual drug. The pharmacist can be useful
in providing such information.

. Pharmacies in some foreign countries administer injec-
tions. This is not advisable since disposable equipment
often is not used. This means that the equipment may not
be sterile, the needles previously used and may, in fact,
promote serious consequences such as infection.

. Diabetic patients who will be traveling in Canada should be
warned that supplies of 80 unit and 40 unit insulin may be
scarce or even non-existent. Patients should be warned of
the potential hazard of using a 40 unit or 80 unit syringe with
U-100 insulin. For this reason patients should either take
their own insulin supplies or be converted to U-100 insulin.
It is necessary to remember to keep insulin supplies under
refrigeration.
. Pregnant women or women of child-bearing age should be
cautioned about purchasing drugs without a prescription
since many drugs taken during the first three months of
pregnancy may cause congenital defects.
. Be very careful in purchasing drugs without a prescription
when traveling abroad. Many of these drugs may contain
potentially injurious drugs. For example, chloramphenicol
which is present in many cough and cold preparations may
lead to a fatal aplastic anemia with prolonged or indiscrimi-
nate use. Likewise, many products may contain
aminopyrine or dipyrone which can cause fatal blood dys-
crasias. Dipyrone is sold in Latin America, for example,
under numerous names and in various drug combinations:

Alginodia (Upjohn)

Conmel (Winthrop)

Diprona MK (McKesson)

Baralgin (Hoechst)

Beserol (Winthrop)

Buscapina Compositum (Boehringer)

Coricidin S/A (Schering)

Corilin Pediatrico Suppositorios (Schering)

Dipirona MK Compuesta (McKesson)

Doriflex (Merrell)

Valpiron (Endo)

(Continued on Page 20)

JANUARY - FEBRUARY - MARCH, 1976

Table of Iron Preparations

Iron Content

Mg.
Unit Elemental
Drug Strength % Fe mEq Fe

Ferrous Fumarate Tablet

(Feostat®) erates a ceae 325 mg. aif (air ape oR:
Ferrous Gluconate Tablet

(FEYQOITe) pier oe bens 320 mg. 12 384 1.5
Ferrous Sulfate, Hydrous

Tablet (Various

Manufacturers) "ie. os euaes 325 mg. 20 65 PB
Ferrous Sulfate, Exsicated

Tablet (Feosol® Tablet) ... 200 mg. 30 ~=—- 60 2.6
Ferrous Sulfate, Exsicated

Capsule (Feosol®

Spansule) Mey wanes wot 150 mg. 30 45 1.8
Ferrous Fumarate

Suspension (Feostat®) .... 100mg/5cc 30 = 30 TZ
Ferrous Fumarate Drops

(FEOStal jee Gems is nee 75mg/5cc 30 22.5 0.9
Ferrous Gluconate Elixir

(FErCOn o mrenenses «0 comer 300mg/5cc 12 36 1.4
Ferrous Sulfate, Exsicated

Elixin(Feosol Elixir) ges. .e 220mg/5cc 30 66 2.8
Ferrous Sulfate, Exsicated

Syrup (Fer-in-sol® Syrup) . 150mg/5cc 30 9 45 1.8
Ferrous Sulfate, Exsicated

Drops (Fer-in-sol® Drops). 125mg/1cc 30 CVE swe an

Table of Calcium Preparations

Calcium Content

Mg.
Unit Elemental
Drug Strength % Ca mEq Ca
Calcium Carbonate and Soda
‘Tab leteeranies een eae eos 650 mg. 40 263 (Ke,
Calcium Gluconate Tablet ... 1Gm 9 92 4.6
Calcium Lactate Tablet ..... 300 mg. 13 oi 1.9
Neo Calglucon Syrup
(Ga Glubionatele ewe. 1.395Gm/4ml 9 92 4.6
(equivalent
to 1Gm)
Ca Gluconate
Calcium Chloride Oral
Solutioniteweee ae oreo: 2Gm/5ml 28 550 36.0
Calcium Chloride Injection . 1Gm/10ml_ 27 272 13.6
Calcium Gluconate
INJCCHON. i. on eee a ces ae 1Gm/10mI 9.8 97.5 4.87
*Also contains calcium d-saccharate as stabilizer
17

A few may match our prices.
Butnoonecan beat oursystem

Sig

y |eceay SUE

sam BUFFER: BUIFERNG BUFF.

7 SOR a

Pertussett

cough
syrup

We're not fooling ourselves.

Gilpin’s grown as much as it has in
the past 130 years because we've beat a
lot of people on price. And we're not
about to change now.

The problem is, a lot of items these
days will cost the same at virtually all
wholesalers. So now we’re not talking
just price.

Now we're talking Datarex*

Datarex® is a
completely auto-
mated, inventory
management system ~
designed to cut your
labor costs while
increasing your sales
and profits. Individualized to your exact
specifications, your Datarex® system will
be as extensive or as limited as you want

it to be.

Beating the high cost of yesterday’s
prices.

It’s been estimated that the average
pharmacy loses up to 2% of its bottom-
line profits because its price stickers
have failed to keep pace with inflation-
ary changes.

Datarex® makes all the adjustments
automatically. Automatically.

The hole in your shelf, the drop in
your curve.

We found out
something else 3
about the average _
pharmacy: it loses #]®
up to 15% of its
possible sales "
because of ree roce anrains yeivee

Datarex® puts an end to outs.

Coded shelf labels work in con-
junction with the computerized in-store
ordering terminal and the Datarex”
CRT order-entry system to keep you
in-stock. All the time.

Should you be doing what you're doing?

Right now you're probably spending
a lot of your time checking stocks,
ordering and filling shelves.

What you should be doing is
managing.

In minutes, anyone in your store can
be running the whole system, freeing
your management team to do the jobs
that build your profits.

Sound expensive? Wrong.

A Datarex® system can cost as little
as $50 a month.

You see, we're a total-service whole-
saler, and we want all your business. All
of it. So we know we can’t afford to
charge you too much for any one service
—even a service like Datarex®

As we said, we're not fooling
ourselves.

You can’t beat the system:
The Datarex® system from Gilpin.

sleniententeniantenteninteenienienanieiante

901 Southern Avenue
Washington, D.C. 20032
Phone (301) 630-4500

Attention Harrison L. Leach
Vice President Retailer Services

I want to know more about the
system. Send me your free Datarex™
booklet.

Name

Firm

Address

City __ State Zip

‘elasieeeetesiantanenien

ap a oF as

Diodohydroxyquin (Diodoquin®, Searle or iodo-chlorhy-
droxyquin) a drug available in many foreign countries for
treatment of intestinal amebiasis may also be prescribed for
“chronic nonspecific diarrhea” in young children. This
drug may cause optic atrophy and permanent loss of vision
if improperly used. Rather than treat oneself with this drug
it is wiser to consult an American trained physician.

The Proper Use of Protamine
as a Heparin Antagonist

In treating heparin overdose and for neutralizing heparinized
blood in dialysis or cardiopulmonary bypass, the drug of choice
is protamine sulfate. Protamine sulfate injection, U.S.P., is
available as a 1 percent solution (50 mg/5 ml. ampule) (1).

Proper administration of protamine sulfate is important for
several reasons. If administered too rapidly, hypotension,
bradycardia, dyspnea, and transitory flushing may occur (2, 3).
In case of an overdose, protamine sulfate may inhibit the
thrombin-fibrinogen reaction and hence act as an anticoagulant
(3, 4).

In order to minimize these complications, several factors in
the proper dosing and administration should be considered.
First of all, an in vitro test should be done to determine the
length of time it takes for the patient's blood to return to nor-
mal, Next, I.V. protamine should be administered slowly in
divided doses (no more than 50 mg. over a ten-minute period)
(1, 3). One mg. of protamine sulfate neutralized 78-95 U.S.P.
units of heparin activity derived from lung tissue (1, 3, 4). (This
equivalence may vary, depending upon the source and man-
ufacture of the heparin.) Since one-half of heparin is eliminated
from the body within one and one-half hours (5), the amount of
protamine administered is reduced in proportion to the time
elapsed from the last heparin injection by about 1 mg./minute
(2). In conclusion, proper use of protamine in the treatment of
heparin overdose can possibly avert further drug-induced prob-
lems.

References upon request.

Sinemet® (Carbidopa-Levodopa combination)

Indications: Sinemet®, a combination of levodopa and Car-
bidopa ina 10:1 ratio, is indicated in the treatment of idiopathic
Parkinson’s disease, post-encephalitic parkinsonism, and
symptomatic parkinsonism produced by manganese and car-
bon monoxide intoxication. It may allow use of lower doses of
levodopa with a resulting decrease in incidence of certain ad-
verse effects such as nausea, vomiting and cardiac arrythmias.
Sinemet® also permits more rapid dosage titration and the use
of supplemental pyridoxine if necessary.

Mechanism of Action: Carbidopa by inhibiting the peripheral
metabolism of levodopa allows more levodopa to enter the
brain.

20

Dosage: Sinemet” tablets are available in two strengths:
10/100 (10 mg. carbidopa, 100 mg. levodopa) and 25/250 (25 mg.
carbidopa, 250 mg. levodopa). Initially patients are usually
begun on Sinemet® 10/100 t.i.d. and the dose is titrated upward
to six tablets daily. Sinemet® 25/250 is usually substituted if
higher dosages are necessary. The maximum recommended
dosage is eight tablets of Sinemet®™ 25/250.

Adverse Effects: Due to increased brain levels of levodopa,
C.N.S. side effects are increased. These side effects include
choreiform, dystonic, and other involuntary movements as well
as various mental changes (e.g. hallucinations, depression,
paranoia, delusion, agitation, etc.) and convulsions.
Precautions:

1. It is especially important to be sure that the patient under-
stands that it is not necessary to continue levodopa therapy
once Sinemet® is started. Levodopa therapy should be dis-
continued at least eight hours before Sinemet® is begun.

2. Patients with well controlled chronic wide angle glaucoma,
if treated with Sinemet®, should be monitored closely for
intraocular pressure changes.

3. Sinemet® should be administered cautiously to the follow-
ing: patients with severe cardiovascular or pulmonary dis-
ease, bronchial asthma, renal, hepatic or endocrine disease
and peptic ulcer patients. As with extended therapy with
levodopa, patients receiving chronic Sinemet® therapy
should have periodic reviews of hematopoietic, hepatic,
renal and cardiovascular function.

4. Sinemet® should not be given to nursing mothers and
should be used in women of childbearing age only when
therapeutic benefits outweigh the risks to the unborn child.

5. Patients should not receive concomitant monoamine
oxidase inhibitors and Sinemet®. This may result in hyper-
tension, flushing of the face, light headedness and pound-

ing of the heart. Some studies have also suggested that
concomitant MAOI and levodopa or Sinemet® therapy may
worsen akinesia and tremor.

Comment: Sinemet® offers an alternative to traditional
levodopa therapy. It is characterized by less nausea, vomiting
and cardiac arrythmias and allows more rapid dosage titration
and the use of supplemental pyridoxine if necessary. These
advantages should be weighed, however, against the increased
potential for C.N.S. adverse effects.

(References upon request)

Furosemide — Chloral Hydrate
Interaction

An adverse effect was observed in cardiac patients who re-
ceived 40-120mg. of I.V. furosemide (Lasix”) preceded by noc-
turnal sedation with chloral hydrate (Noctec®) in the same 24
hour period. The reaction consisted of diaphoresis, hot flashes,
variable blood pressure including hypertension, and uneasi-
ness. Intravenous furosemide which was not preceded by
chloral hydrate in the prior 24 hours did not cause the reaction,
nor, did the reaction occur when flurazepam (Dalmane®) was
substituted.

lJ. Amer. Med. Assoc., 232 (6), 638 (1975)]

THE MARYLAND PHARMACIST

Insulin Dosage Errors

The introduction of U-100 insulin has led to certain insulin
dosage errors. These dosage errors involve the “dead-space-
volume” of insulin syringes. Dead-space-volume (D.S.V.) is
usually defined as the non-measured volume in the syringe tip,
needle hub and needle shaft. The D.S.V., depending on syringe
“manufacturer, may represent a volume of 0.01 to 0.1 ml. (1-10
units of U-100 insulin). While this error may not be significant
where large doses of insulin are used, it can be very significant

when small amounts of insulins are mixed. For example, if a
patient has been stabilized on 10 units of regular and 18 units of
NPH insulin it has been shown that the ratio of insulin drawn
into the syringe may vary from as much as 10:18 to 18:10 de-
pending on the syringe used.

The following chart lists the D.S.V. for various insulin
syringes:

Manufacturer Syringe D.S.V.s
(units of U-100 insulin)
Sherwood 8 units
Eisele 9 units
B-D trace
Pharmaseal 5 units

If confronted with a previously stable diabetic patient who is
no longer controlled on an insulin mixture one should consider
this insulin dosage error. It should be ascertained, then,
whether there has been a change in the brand of syringe used,
or in the order of insulin mixing. It might, in fact, be wise to
instruct diabetic patients not to change the brand of syringe
used nor the order of insulin mixing.

Some syringe manufacturers have begun to include copies of
cautionary statements in bulk packages of syringes. As of July 6,
1976, however, all manufacturers will be required to include a
label warning and cautionary statement for all insulin syringes.

(References upon request)

Parenteral Digoxin

Absorption of digoxin after I.M. injection is erratic and in-
complete. It also causes tissue damage. These considerations
argue strongly, then, against intramuscular administration of
digoxin.

[Clinical Pharmacology and Therapeutics, 16 (3), 433 (1974)]

Oral vs. I.M. Diazepam

Oral diazepam gives faster, higher blood levels when com-

pared to I.M. administration of the drug.
Route of Peak

Administration

Time to Reach

Concentration Peak Concentration

I.V. 1,607ng/ml 15 min.
I.M. 293ng/ml 60 min.
P.O; 492ng/ml 30 min.

[Clinical Pharmacology and Therapeutics, 16 (3), 483 (1974)]

JANUARY - FEBRUARY - MARCH, 1976

Aluminum Hydroxide
Equivalency of Basaljel®

Al(OH); Elemental Al

Basaljel Suspension 408meg/5cc = 141 mg/5cc
Basaljel Extra Strength

Suspension 1000mg/5cc = 334m g/5cc

Basaljel Capsule 500mg/cap 173mg/cap

Basaljel Tablet 500mg/tab = 173mg/tab

(Wyeth Laboratories)

Stability of 1.V. Ampicillin

The Department of Institutional Pharmacy Programs I|.V. Ad-
mixture Service has revised its policy on preparation of I.V.
ampicillin. This change is the result of new stability data con-
cerning ampicillin. Recent articles (1) have shown, for example,
that ampicillin is stable for 24 hours in normal saline with ap-
proximately 10 percent loss in potency. In contrast, traditional
dilution with 5 percent Dextrose in Water (DsW) could lead to as
much as 50 percent loss in 24 hours.

PERCENT DEGRADATION OF 1% AMPICILLIN IN NORMAL SALINE
AND 5% DEXTROSE IN WATER ACCORDING TO TIME AND
TEMPERATURE (27°C)

Normal Saline 5% Dextrose

in Water
4: NOUIS oar coe ee 1.0 Be rn ee: 2135
Si NOULSSe oe en eee ee re Di O wetness a ein: Sy Pal
ZA: NOUTS He aces fae BB eerie ee ees 46.5

Ampicillin’s increased stability in normal saline as compared
to DsW is attributed to: a) a higher buffering capacity which
maintains the pH of the ampicillin in normal ranges (9.3 to 9.4),
b) Dextrose enhances the auto-hydrolysis of ampicillin at all
temperatures.

Due to this enhanced stability in normal saline, the I.V. Ser-
vice will now prepare the ampicillin orders if the physician’s
order sheet specifically states the information:

a. the exact dose of ampicillin
b. the times of administration
c. normal saline as the vehicle
d. the volume of the vehicle

For example: AMPICILLIN 250 mg. IV qg6h in 100cc. NORMAL
SALINE

NOTE: All ampicillin reconstituted by physician or nurse on

the nursing unit must still be discarded within ONE
HOUR.

Unless specified on the physician’s order sheet that
normal saline is the vehicle, it will still be assumed
that DsW is the vehicle of choice and that the ampicil-
lin is to be prepared by the nurse or physician.

References
1. D. Savello and R. Shangraw, ‘Stability of Sodium Ampicillin
Solutions in the Frozen and Liquid States’’, Amer. J. Hosp.
Pharm. 28, pg. 754 (Oct.) 1971.
2. P. Hiranaka and A. Frazier, ‘Stability of Sodium Ampicillin
in Aqueous Solutions”, Amer. J. Hosp. Pharm. 29, pg. 321
(April) 1972.

21

When it's up to you...

Keep the cost down for them

250 mg. tablets cost 40-7

“Based on 1975 Drug Topics Red Book

1000 tablet cost of PEN VEE* K based. on 10 x 100 bottles

1000 tablet cost of V-CILLIN K®* based on 2 x 500 bottles
1000 tablet cost of LEDERCILLIN® VK based on 1 x 1000

PEN VEE® K is a registered trademark of Wyeth Laboratories

V-CILLIN K® is a registered trademark of Eli Lilly and Company.

For Oral Solution:

125 mg (200,000 units)/5cc; when reconstituted
80, 100, 150 and 200 cc bottles

250 mg (400,000 units)/S5cc; when reconstituted
80, 100, 150 and 200 cc bottles

Indications: For the treatment of susceptible infections;
€.g., pneumococcal infections (respiratory tract), staphylococcal
infections (skin and soft tissue). For full list of approved indica-
tions consult labeling.

Contraindications: Previous hypersensitivity to penicillin.

Warning: Serious, occasionally fatal anaphylactoid reactions have
been reported: more likely with sensitivity to multiple allergens
Some with penicillin hypersensitivity have had severe reactions
to cephalosporin; inquire about penicillin, cephalosporin, or other
allergies before treatment. If such occurs, discontinue drug and
treat withusual agents (e.g., pressoramines, antihistamines,
corticosteroids).

Precautions: Use with caution in those with histories of signifi-

LEDERLE LABORATORIES, A Division of American Cyanamid Co, Pearl River, New York 1096

Also available:
Tablets:

250 mg (400,000 units)
bottles of 100 and 1000; unit-dose 10x 10's

500 mg (800,000 units)
bottles of 100; unit-dose 10 x 10’s

cant allergies and/or asthma. Do not rely on oral administration
in patients with severe illness, nausea, vomiting, gastric dilata-
tion, cardiospasm or intestinal hypermotility. Occasional patients
will not absorb therapeutic oral amounts. In streptococcal infec-
tions, treat until organism is eliminated (10 days minimum) and
demonstrate elimination by follow-up culture. With prolonged use,
nonsusceptible organisms, including fungi, may overgrow, treat
superinfection appropriately.

Adverse Reactions: Hypersensitivity, including fatal anaphy-
laxis. Nausea, vomiting, epigastric distress, diarrhea, black hairy
tongue. Skin eruptions, urticaria, Serum-sickness reactions, laryn-
geal edema, anaphylaxis, fever, eosinophilia. Infrequent hemo-
lytic anemia, leukopenia, thrombocytopenia, neuropathy,
nephropathy, usually at high parenteral dosage.

5
809-6

maryllanc board
of elnaninacy

Pharmacy changes for December:

New Pharmacies
MSC-Rx, Earl L. Linehan, President; 9-C West Aylesbury Road,
Timonium, Maryland 21093.

Changes Of Ownership, Address, Etc.

None.

No Longer Operating As Pharmacies

Garrison Pharmacy, Joseph Fine; 4709 Garrison Boulevard,
Baltimore, Maryland 21215.

Cecilton Pharmacy, George M. Schmidt; Box 25, Cecilton,
Maryland 21913.

Morrison and Fifer, C. and L. Witzke; 3536 Ellerslie Avenue,
Baltimore, Maryland 21218.

Charlesmont Pharmacy, Harmond Amernick, President; 3203
Old North Point Road, Baltimore, Maryland 21222.

Hanks Pharmacy, E. Guy Dowling, President; 221 Maryland
Avenue, Cumberland, Maryland 21502.

Two new firsts from District Photo!

Pharmacy changes for January:

New Pharmacies

Washington Heights Pharmacy, Lawrence Hogue, President;
205 Washington Heights Medical Center, Westminster, Mary-
land 21157.

Changes Of Ownership, Address, Etc.

MacLarty’s Linthicum Pharmacy, David C. MacLarty; 400 S.
Hammonds Ferry Road, Linthicum, Maryland 21090. (Change of
ownership; was: R. T. Lathroum.)

Sentry Drug Center #2, David Kastens, President; 1818 Vir-
ginia Avenue, Hagerstown, Maryland 21740. (Change of
ownership; was: James E. Allen, President.)

Eastpoint Medical Center Pharmacy, Inc., Philip M. Piasecki,
President; 1012 Old North Point Road, Baltimore, Maryland
21224. (Change of ownership; was: Leonard Lesser, President.)

No Longer Operating As Pharmacies

J. R. J. Pharmacy, Inc., James Baze, President; 2140 W. Balti-
more Street, Baltimore, Maryland 21223.

Turns snapshots into personalized picture postcards and greet- >

ing cards. Encourages customers to order extra prints — those

to mail, those to keep.

PLUS FOTO-DATE Puts the date on the back of each

print, to tell the month and the year it was devel-

oped. A handy record your customers appreciate.

Both at no extra cost to you or your customers!

Both designed to build your photo-finishing profits!

You get both of these tremendous profit-boost-
ing features FREE when you’re a District Photo
Dealer. We’re the company that’s first with the
best new developments in photo-finishing —
Big Shot Borderless Photoprints, Bonus Photo,
Silk-Finish, and One-Day Service.

We believe in firsts, because they keep you first
in sales. oe

Call us. In D.C., 937-5300. In Baltimore, 792-7740.

FOTO DATE: AUG., 1975

Mer Wp se

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Beans 20 Ae Post Card
boore 4 /
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“Ae
Pat pending

POST-A- PHOTO rersonatizeo POSTCARD & GREETING CARD
»
A
,

DISTRICT PHOTO ING

10619 BALTIMORE AVENUE, BELTSVILLE, MARYLAND 20705

24

THE MARYLAND PHARMACIST

|

ASPIRIN...
AFTER THREE QUARTERS OF A CENTURY

By John C. Krantz, Jr., Ph.D.
Professor Emeritus
Department of Pharmacology
School of Medicine
University of Maryland

Pain is the arch enemy of mankind. It has thwarted his prog-
ress all along his ascent from a dweller in cliffs to the occupant
of a modern skyscraper. And man has ransacked this entire
earth to acquire a surcease from pain. In the beginning of his
search the plant kingdom was his principal source of remedies.
However, with the advent of synthetic organic chemistry, ini-
tiated by Woehler in 1828, hundreds of new chemical com-
pounds were made available for trial. Among these agents was
aspirin which was synthesized by von Gerhardt in 1853. It re-
mained in the chemist’s laboratory as just a new compound
until the turn of the century.

In 1899 Felix Hoffman, achemist with the Bayer Company, and
J. Wohlgemut, used aspirin first in the treatment of rheumatic
disease. Hoffman's father was being treated with sodium salicy-
late for his pain, but he did not tolerate the drug well. His son
changed the therapy to aspirin, which appeared to be better
tolerated and more effective. This initiated the use of aspirin in
Europe and soon its popularity in America was demonstrated by
its rapid replacement of the other analgesics such as antipyrine,
aminopyrine and acetanilid and phenacetin. Indeed, at the
present time, itis estimated that the American public consumes
daily more than 20 tons of aspirin in various dosage forms. Most
of this aspirin is taken in the form of OTC products without
medical advice.

It has often been said, ‘Drugs are like the finger of God, they
can heal and they can smite.’’ Seldom does one find an effective
drug without side-effects. And the skillful physician always
weighs the therapeutic merit of the drug against the anticipated
side-effects. Weighed in this balance, aspirin is one of the most
remarkable drugs used in the treatment of symptoms and dis-
ease.

For example, on the “heal” pan of the scale, aspirin is a
specific drug in the treatment of rheumatic fever. It is an
analgesic in the neuromuscular pains of grippal conditions.
Aspirin is a dependable antipyretic and anti-inflammatory
agent. The analgesic and anti-inflammatory properties make the
drug useful in the prolonged treatment of mild arthritic states.
Adding additional smaller weight to the ‘‘heal’’ pan is the fact
that aspirin in large doses evokes hypoglycemia and
hypocholesterolemia. Besides, there is some indication that its
action upon the platelets of blood, preventing their aggrega-
tion, is effective in the prevention of cardiovascular problems
such as heart attack.

Now, on the “smite’’ pan of the balance, one finds that in
susceptible people, aspirin produces gastric discomfort and
possibly bleeding from the gastric mucosa. It has been esti-

mated by Levy (1974) that the incidence of gastric bleeding

JANUARY - FEBRUARY - MARCH, 1976

among heavy aspirin users is about 0.015 percent. Allergic re-
sponse to aspirin is rare. Aspirin is toxic in massive doses.
Generally this occurs in children and is due to massive doses of
candy or adult aspirin. It appears therefore, that the pre-
dominating untoward side-effect of aspirin is gastric discomfort
with or without gastric mucosal bleeding. Let us look back over
the three-quarters of the past century and learn what Dr. Julius
Wohlgemut, who was one of the first two to use the drug, had to
say about it.

The drug is best given in solution. Since itis insoluble in water
he suggested the use of alcohol to facilitate the solubility. Also,
in the pre-aspirin era, when sodium salicylate was the drug of
choice in rheumatic disease, it was generally given in much
water along with sodium bicarbonate. Following the advice of
our forebears, it is prudent to take aspirin, well buffered and
dissolved in water. Fortunately the former facilitates the latter in
effervescent preparations. Smith, Paul (1957) stated, ‘Medicine
and the world at large are fortunate to have found such a drug.”

The NACDS-Lilly Digest
Current Trends in
Chain Pharmacy Operations

Results of the NACDS-Lilly Digest for 1974, recently released,
show that prescription sales in chain drugstore units amounted
to $195,675 or 16.5% of total sales, up from 16.1% the previous
year and the highest since the first NACDS-Lilly Digest was
published in 1971. Sales of other merchandise totaled $986,959
— the remaining 83.5% of the total which averaged $1,182,634
per store, or 11.8% over 1973. This was higher than the average
annual sales growth of 8.6% recorded since the chain pharmacy
study was first published. A total of 1,461 pharmacies partici-
pated in the 1974 survey.

In a period of very high inflation, the average chain unit
showed an increase of only 0.1% in the cost-of-goods-sold — to
71.9% of sales. At the same time, a 0.3% decrease in total
expenses was recorded, as a result of which net profit before
taxes rose from 4.6% to 4.8% of sales. Dollarwise, net profit
went from $48,555 per unit to $56,546, an increase of $16.5%.
However, because of a reduction in total expenses as a percen-
tage of sales, net profit was up 0.2% over 1973.

Other highlights of the NACDS-Lilly Digest for 1974: Man-
ager’s salary averaged $24,178 (2.0%) vs $19,373 (1.8%) in 1973;
employees’ wages amounted to $110,880 (9.4%) vs $103,024
(9.7%); and rent was $32,588 (2.8%) vs $30,244 (2.9%). Total
expenses per store in 1974 amounted to $276,267 or 23.3%
compared to $250,023 or 23.6% the year before.

as

BALTIMORE METROPOLITAN
PHARMACEUTICAL ASSOCIATION
60th ANNUAL BANQUET

The Baltimore Metropolitan Pharmaceutical Association held
its 60th Annual Banquet and Dance on Sunday evening, Febru-
ary 8, 1976, at the Blue Crest North on Reisterstown Road in
Pikesville.

John E. Padousis, President of B.M.P.A., opened the evening
and welcomed the guests after which George J. Stiffman, Past
Vice President of B.M.P.A., delivered the Invocation.

B.M.P.A. Vice President and Banquet Chairman Stanley J.
Yaffe served as Toastmaster for the evening.

The installation of Officers and the Executive Committee for
1976 followed: Mark J. Golibart, Honorary President; Ronald A.
Lubman, President; Stanley J. Yaffe, President Elect; Samuel
Lichter, Ralph T. Quarles, and Milton C. Sappe, Vice Presidents;
Nathan I. Gruz, Executive Director; Charles E. Spigelmire,
Treasurer; and John E. Padousis, Chairman of the Executive
Committee.

Executive Committee are: Elwin H. Alpern, Barry L. Bloom,
James B. Culp, Jr., Marvin A. Friedman, Barry E. Levin, Martin B.
Mintz, Richard E. Myers and Bernard N. White.

Following the installation, new president Ronald A. Lubman
delivered a brief address after which Mark J. Golibart, a long
time representative of Abbott Laboratories, was presented with

the Honorary President’s Plaque by Nathan |. Gruz, Executive
Director of the B.M.P.A. and the Maryland Pharmaceutical

Association.

Mr. Lubman then presented the first AID Drug Stores Award,
“In recognition of his outstanding contribution to pharmacy in
the State of Maryland’’, to Charles E. Spigelmire, Treasurer of
the B.M.P.A. John E. Padousis received the Past President's
Plaque from Toastmaster Yaffe.

After the distribution of awards and prizes, B.M.P.A. mem-
bers and their guests enjoyed an evening of dancing to the
music of Al Miller’s Orchestra.

Serving on the Banquet and Dance Committee were: Stanley
J. Yaffe, Committee Chairman; Milton C. Sappe, Ticket Chair-
man; Ronald Lubman, Charles E. Spigelmire, John E. Padousis
and Nathan |. Gruz.

(Upper) John E. Padousis (right) receives the Past President’s
Plaque from Stanley J. Yaffe, Banquet Chairman.

(Center) Charles E. Spigelmire (right) receives the AID Award
from Ronald A. Lubman, newly elected President of the Balti-
more Metropolitan Pharmaceutical Association.

(Lower) Mark J. Golibart (left) of Abbot Laboratories receives
the Honorary President's Plaque of B.M.P.A. from Nathan I.
Gruz, Executive Director, B.M.P.A. and MPhA.

26 THE MARYLAND PHARMACIST

WHEN LICE STRIKE,

CALL COO-431-1140.

It’s the A-200 Pyrinate’ Lice Alert Hotline.

The sooner a lice outbreak is recognized, the easier it is to
stop. So when lice strike in your area, strike back! Call us toll free
at the Hotline Number 800-431-1140. Once the outbreak is verified,
we'll swing into action with a whole program designed to stop an out-
break before it gets rolling.

We'll send you a Lice Epidemic Kit to help combat the out-
break. Kit contains patient literature, instruction pad printed in both
English and Spanish, diagnosis and treatment file card, and 2’ x 3’
lice wall poster.

We'll also make sure there’s enough A-200 Pyrinate available
to wholesalers and retailers in the area to meet the need. We'll inform
your local health officials of the emergency. And we'll run local news-
paper and radio advertising to alert the whole community.

And to thank you for your quick thinking, we'll send you a gift
you can use in your professional practice.

If we all work together, we can beat this lice problem. First step
is to contact the A-200 Pyrinate Lice Alert Hotline Number,
800-431-1140. A good deal for your town. A great deal for you.

Note: When you call please give us your
name, professional title, address, name and phone
number of local health officer, and details of
outbreak.

© 1976, Norcliff Thayer Inc.

NO TOOLS NEEDED.

Empirin Compound 250's
Still have easy-open,easy-close, fiddle-free caps

250 TABLETS NDC-81-306-65

EMPIRIN’
COMPOUND
ANALGESIC

This

Each table: ee [Of households without young children.

ei ; aspirin 34% in 246
vat % gy BSD IFIN 3p gr, phenacetin

Good sales sense Good profit sense, too

No need to create cap-opening difficulties for Every Empirin Compound “250” you sell can bring
people who can't cope with child-resistant you a profit of up to $1.10* Yet one facing uses only
closures. The elderly and the handicapped. House- 4% inches—scarcely more than most analgesic
holds without children. (To accommodate these 100's do.

users, €ach Manufacturer of aspirin-containing
analgesics is permitted by law to make one size
available without a safety closure.)

The Empirin Compound 250 tablet bottle is the Burroughs Wellcome Co
right choice for them. Easy to open. Easy to close. aval / ,

Make the most of every analgesic inch on your shelves.
Make it with Empirin Compound 250s.

*Based on suggested list prices

Research Triangle Park
Easy to take.

Wellcome / North Carolina 27709

News

Second USP — NF Supplement Published

The United States Pharmacopeial Convention, Inc. has pub-
lished a Second Cumulative Supplement to USP XIX and NF XIV.
This combined USP and NF Supplement is arranged in a single,
composite listing which emphasizes the unification of the offi-
cial compendia. Pursuant to the acquisition of the National
Formulary as of January 2, 1975, responsibility for all NF XIV
supplements and for all future NF editions resides within the
Pharmacopeial organization.

Holders of the main volume of USP XIX and NF XIV will need
only one copy of the Second Supplement to bring both books
up to date. The Second Supplement will be cumulative and
therefore supersedes entirely both the First Supplement and
First IRA. All revisions in the Second Supplement are official as
of May 1, 1976, except where otherwise noted.

Dispensing information similar to that given in USP XIX
monographs of drugs dispensed directly by pharmacists to pa-
tients is provided for all comparable NF drugs.

The Supplement provides a total of 34 new USP XIX mono-
graphs, of which 7 are new in the Second Supplement, and a
total of 26 new NF XIV monographs, of which one is new with
this supplement. The revisions included pertain to 271 USP XIX
and 395 NF XIV monographs; 13 USP XIX and 3 NF XIV general
chapters; 34 USP XIX and 24 NF XIV reagent specifications; and
one NF XIV reference table. No new changes in the General
Notices have been made. In all, the Supplement covers 802
compendial titles, of which 476 represent changes newly
adopted with the Second Supplement.

Comprising about 140 pages, 8%'' X 11%’, the Second Sup-
plement will include the rosters of the USPC officers and board,
the USP Committee of Revision and its Subcommittees, and the
current USPC Constitution and Bylaws.

The revisions in the Second Supplement were subjected to
pubic review while they were being considered by the USP
Committee of Revision through publication in the bimonthly
Pharmacopeial Forum, the journal of drug standards develop-
ment and official compendia revision. The wide access to the
USP and NF revision process provided by Pharmacopeial Forum
affords broad participation by medical, pharmacy, and allied
sciences experts throughout the nation and aids the USP Com-
mittee of Revision in its scientific studies and deliberations.

The Second Supplement is available at $3.00 per copy (cash
with order), from the USP Convention, Inc., 12601 Twinbrook
Parkway, Rockville, Maryalnd 20852. The price of USP XIX was
increased a like amount to $28.00 on January 1, 1976 and pur-
chasers of USP XIX after that date are entitled to a free copy of
the Second Supplement when they return the supplement card
on the front flap of the USP XIX book jacket.

Annual Supplements are anticipated during the 1975-1980
lustrum. As a convenience to purchasers to reduce the cost of
individual orders and to insure that all Supplements are re-
ceived promptly as published, a Lustrum Plan has been initiated
whereby purchasers may subscribe to the Second and all suc-
ceeding Supplements now for a total of $12.

NEW MEMBERS

Jerome Berger, Baltimore

Herbert Wienner, Baltimore
Robert Baxter, Pasadena

Irwin Sealfon, Silver Spring
Joseph Breslow, Randallstown
Zach Turner, Baltimore

David Clarke, Towson

Arnold Grabush, Baltimore

Leon Shuster, Baltimore

Dr. Robert Kroopnick, Randallstown
Milton Waxman, Elkton

Mrs. Irving Freed, Baltimore
Isidore E. Singer, Baltimore
Elizabeth Newcomb, Annapolis
Larry Small, Randallstown

Gary Mason Cohen, Gaithersburg

JANUARY - FEBRUARY - MARCH, 1976

Barbara Dorsch, Ellicott City

David Oken, Pikesville

Michael Roberts, Millersville

Marvin H. Abrams, Baltimore

Joseph House, Keyser, West Virginia
Frank Evans, Cambridge

Mary Hubbard, Greenbelt

John Roslyn, Baltimore

William Wilson, Glen Burnie

Robert Cherricks, Snow Hill

Raymond Corry, Poughkeepsie, New York
Robert Henderson, Baltimore

Samuel Markin, Baltimore

Daniel Greif, Baltimore

James Rutten, Bowie

Valyapuri Subramaniam, Chevy Chase

29

LIBRIUM
(chlordiazepoxide HCl)

FOR ALL THE RIGHT
REASONS.

= — ae ia c as. PERFORMANCE. A MATTER OF RECORD

Librium has long been recognized as an effec-
tive and safe antianxiety agent. Patients taking
Librium seldom experience serious side effects or in-
terference with mental acuity (see summary of prod-
uct information on following page for additional
information). Furthermore, Librium has been used
in conjunction with many primary medications.

In dispensing Librium, the pharmacist also
benefits. As the originator and developer of Librium,
Roche Laboratories offers you ready access to the
extensive technical information compiled on this
psychotherapeutic agent over the past 15 years. You
can also take advantage of the additional compli-
mentary services provided by Roche that are rele-
vant to the interests and problems of your profession.

MEDICAL EMERGENCY LINE

One way Roche provides immediate product
information is through the Medical Emergency
Line. Roche maintains this direct, 24-hour tele-
phone service (201-235-2355) for specific questions
concerning Librium or any other Roche product.
For inquiries of lesser urgency, Roche information
specialists will supply detailed responses by mail. Of
course, your Roche representative is prepared to
supply you with a variety of informative materials,
such as scientific brochures, reprints and bibliog-
raphies related to the pharmacology of Librium
(chlordiazepoxide HCl) and its clinical applications.

Code 201

23572355

THE NEW ENVIRONMENT OF PHARMACY

‘Two years ago we initiated a highly
successful educational service —

The New Environment of

» Pharmacy. It was designed

by pharmacists for phar-

macists. The purpose is

» tokeep you informed of

) current trends in pharmacy

and the changing factors affecting

~ your profession. Subjects covered include

new government regulations, drug interactions and

new concepts and techniques in pharmacy manage-

ment. If your pharmacy has not already enrolled in this

program, write: The New Environment of Pharmacy,

Roche Laboratories, Division of Hoffmann-La Roche

Inc., P.O. Box 283, Nutley, New Jersey 07110.

LIBERAL
RETURN GOODS POLICY
Although the demand for Librium

minimizes expiration problems for this
product, Roche continues its policy of
expediting replacements of all Roche
products that may be outdated or dis-
continued. This liberal policy enables
you, as a busy pharmacist, to keep your
stock up to date and to maintain a
proper inventory.

_LIBRIUM

chlordiazepoxide HCI/Roche

5 mg, 10mg, 25mg capsules

FOR ALLTHE PROFESSIONAL
EASONS.

ANUARY - FEBRUARY - MARCH, 1976

Please consult complete product information,
a summary of which follows:

Indications: Relief of anxiety and tension
occurring alone or accompanying various disease
states.

Contraindications: Patients with Known hyper-
sensitivity to the drug.

Warnings: Caution patients about possible
combined effects with alcohol and other CNS
depressants. As with all CNS-acting drugs, caution
patients against hazardous occupations requiring
complete mental alertness (e.g., operating
machinery, driving). Though physical and psycho-
logical dependence have rarely been reported on
recommended doses, use caution in administering
to addiction-prone individuals or those who might
increase dosage; withdrawal symptoms (including
convulsions), following discontinuation of the drug
and similar to those seen with barbiturates, have
been reported. Use of any drug in pregnancy,
lactation or in women of childbearing age requires
that its potential benefits be weighed against its
possible hazards.

Precautions: In the elderly and debilitated,
and in children over six, limit to smallest effective
dosage (initially 10 mg or less per day) to preclude
ataxia or oversedation, increasing gradually as
needed and tolerated. Not recommended in chil-
dren under six. Though generally not recom-
mended, if combination therapy with other
psychotropics seems indicated, carefully consider
individual pharmacologic effects, particularly in
use of potentiating drugs such as MAO inhibitors
and phenothiazines. Observe usual precautions in
presence of impaired renal or hepatic function.
Paradoxical reactions (e.g., excitement, stimula-
tion and acute rage) have been reported in psy-
chiatric patients and hyperactive aggressive
children. Employ usual precautions in treatment of
anxiety states with evidence of impending depres-
sion; suicidal tendencies may be present and
protective measures necessary. Variable effects on
blood coagulation have been reported very rarely
in patients receiving the drug and oral anticoagu-
lants; causal relationship has not been established
Clinically.

Adverse Reactions: Drowsiness, ataxia and
confusion may occur, especially in the elderly and
debilitated. These are reversible in most instances
by proper dosage adjustment, but are also occa-
sionally observed at the lower dosage ranges. Ina
few instances syncope has been reported. Also
encountered are isolated instances of skin erup-
tions, edema, minor menstrual irregularities,
nausea and constipation, extrapyramidal symp-
toms, increased and decreased |ibido—all infre-
quent and generally controlled with dosage
reduction; changes in EEG patterns (low-voltage
fast activity) may appear during and after treat-
ment; blood dyscrasias (including agranulocyto-
sis), jaundice and hepatic dysfunction have been
reported occasionally, making periodic blood
counts and liver function tests advisable during
protracted therapy.

Supplied: Librium® Capsules containing
5 mg, 10 mgor 25 mg chlordiazepoxide HCI.
Libritabs® Tablets containing 5 mg, 10 mgor
25 mg chlordiazepoxide.

Roche Laboratories
Division of Hoffmann-La Roche Inc,
Nutley, New Jersey 07110

31

compete for the custom-

ers dollars, at your phar-
macy. So, when it comes time
to stock your shelves, TH

A lot of fine ae

Q
=

=i

COMPANY is well aware of your needs. wh

Our product is periodicals — magazines
and paperback books — and we continually
supply your racks with a variety of current
reading material appealing to every taste and
keeping your customer reader interest at its
highest.

We understand that turnover is important.
With periodicals you have a sufficient new
product each month to stimulate traffic not
only for our product, but for a// the products
in your store.

An investment of $100 in periodicals,
normally will result in $127 of sales within 30

CS

g Bo PRP MOLE se

, _ ine : 3 Ee 3.
pe a, N
aig 2 aes hy ‘
a ude: gg BU ty BES ay ¥ Bh
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# 3 ; ¥ : : : ~“

wid ae : ; .

pee sid %, ae 8
a ae é& 4

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ays. Not bad! Then
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But perhaps the most important fact
is that periodicals have an unselfish way of
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store. Take a look at the pages of our maga-
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every other product that you sell over and
over again. It is like having a built-in
salesman.

To learn how you can really ‘help your-
shelf,’’ why not give us a call;
The Maryland News Distributing Co.
(301) 233-4545
Ask about periodicals, the unselfish product.

THE MARYLAND PHARMAC#

|

4

|
\
|

Tuberculosis In Baltimore

Baltimore’s tuberculosis rate, the second worst in the nation
in 1974 (only Honolulu was higher), is expected to be six times
higher than the national average this year. While the national TB
rate is about 16 new cases per 100,000 population, the city’s
projected rate for 1975 is 83 new cases per 100,000. The state’s TB
rate is 29 new cases per 100,000.

State officials believe the restricted use of Isoniazid (INH) has
been a factor in Baltimore’s dramatic increase in the disease in
the past three years. Isoniazid is used for preventive therapy of
tuberculosis in a single dose of 300 mg per day for adults and 10
mg per kg body weight per day, not to exceed 300 mg per day,
for children, to be administered in a single dose over a period of

12 months. A larger dose or longer period of time is not re-
_ quired. INH is inexpensive, administered orally, and easy to
take. As of now, no other drug has been demonstrated to be

effective for preventive therapy.

It is now apparent that mild hepatic dysfunction, evidenced
by elevation of serum aminotransferase (transaminase) activity,
occurs in 10 to 20 per cent of persons taking INH. This abnormal-
ity usually occurs in the first 4 to 6 months of treatment but can
occur at any time during therapy. In most instances, enzyme
levels return to normal with no necessity to discontinue medica-
tion. In occasional instances, progressive liver damage occurs
and presents symptoms; the drug should be discontinued im-
mediately in these cases. The frequency of progressive liver
damage increases with age. It is rare in individuals under age 20.

_ The observed frequency in other age groups is as follows: ages

20-34, up to 0.3 per cent; ages 35-49, up to 1.2 per cent; 50 years

- and more, up to 2.3 per cent.

It must be remembered that the chance of developing INH-
associated liver disease exists only during the year of preventive
therapy, whereas the risk of developing tuberculous disease is

_ present for life. It is to diminish the risk of developing tuber-
culosis, with possible transmission of infection, that INH is

recommended for persons infected with M. tuberculosis. U.S.
Public Health Service studies have demonstrated that the pro-
tection of one year of preventive therapy for those at risk of

_ developing tuberculous disease continues for many years and

may well be lifelong. Up to 15 years of follow-up of groups of
people given preventive therapy with INH has revealed no evi-
dence of delayed deleterious effect. The recommendations out-
lined below for the use of INH with appropriate safeguards are
based on a comparison of the risk of hepatic injury with the

_ benefit of preventive therapy.

Persons for whom preventive therapy is recommended:
every positive tuberculin skin test reactor is at some risk of
developing tuberculous disease and can benefit from preven-

_ tive therapy. Since the risk of developing disease is lifelong, the
_ benefit from preventive therapy is greater the younger the age

'

and the longer the life expectancy. Hepatitis, the most serious

complication of INH therapy, increases with age. The risk of

_ hepatitis is exceedingly low in the less than age 20 group and

reaches a peak among persons more than 50 years of age.

_JANUARY - FEBRUARY - MARCH, 1976

Priorities must be set for preventive therapy, taking into con-
sideration not only the risk of developing tuberculosis com-
pared with the risk of INH toxicity, but also the ease of identify-
ing and supervising persons for whom preventive therapy is
indicated, and their likelihood of infecting others.

The following groups are listed in order of priority: 1. House-
hold members and other close associates of persons with re-
cently diagnosed tuberculous disease. 2. Positive tuberculin
skin test reactors with findings on the chest roentgenogram
consistent with non-progressive tuberculous disease, in whom
there are neither positive bacteriologic findings nor a history of
adequate chemotherapy. 3. Newly infected persons. 4. Positive
tuberculin skin test reactors in the special clinical situations
described below. 5. Other positive tuberculin skin test reactors.
The risk of tuberculosis is highest in infancy, high again in
adolescence and early adult life, and continues at a lower rate
for a lifetime.

Preventive therapy for tuberculosis infection with INH is an
effective tool in tuberculosis control. It is a preventive health
measure which benefits the infected person as well as a valid
public health measure for the community. Its continued use
should be encouraged.

Ref:
1. Official Statement of the American Thoracic Society.
Amer. Rev. Resp. Dis., Vol. 110, 1974, pp. 371-374.
2. Isoniazid Prophylaxis and Deaths in Baltimore, 1972, Md.
State Med. J., Nov., 1974, pp. 64-67.

Tuberculosis Misunderstood

It is easy to understand why people believe tuberculosis is a
highly contagious disease. A TB patient’s every cough contains
hundreds of droplets carrying germs. But the large droplets,
called fomites, are not considered to be a significant way of
spreading tuberculosis. The big droplets are usually too big to
breathe in and they eventually dry up wherever they land. TB is
almost impossible to catch simply by touching the germ. In over
99 per cent of cases, it is breathed in.

It is the little droplets showered out in a cough that are the
problem. The average TB patient, according to Dr. M. Susan
Bollinger, Medical Director at the Mount Wilson Sanitarium,
coughs out 465 of these droplets with every cough, and more
than half are still suspended in the air half an hour later. The
average cough comes four times an hour, for about 2,000 drop-
lets an hour or 45,000 in a 24-hour period. But it takes, on the
average, the breathing in of about 25,000 cubic feet of air to get
enough droplets into the respiratory tract to settle and begin to
cause infection. The more air that the TB patient coughs into,
the less likely it is that anyone around will catch the disease.

Reprinted with permission from: Pharmacy Bulletin, 122, December,
1975, The Union Memorial Hospital,
Baltimore, Maryland.

33

oloiltuaries

MRS. MARY F. DuMEZ

Mrs. Mary F. DuMez, 86, widow of Dr. Andrew G. DuMez,
who served as Dean of the University of Maryland School of
Pharmacy from 1926 to 1948, died on January 29 in Hot Springs,
Arkansas, where she was visiting. Dr. Dumez, who was the first
person to receive a Ph.D. in pharmacy (University of Wisconsin,
1917) inthe United States (although earlier doctoral degrees had
been awarded for work in pharmaceutical chemistry), died in
1948.

The former Mary Fields was a native of Indiana. She attended
college in Boston, where she majored in physical education.
After receiving her B.A. degree, she taught at Oklahoma State
University where she met her husband.

Soon after their marriage, Dr. and Mrs. DuMez went to the
Philippine Islands. There, Dr. DuMez helped to found the Col-
lege of Pharmacy of the University of the Philippines.

Upon the couple’s return to the United States, Dr. DuMez
worked in the Hygienic Laboratory of the United States Public
Health Service.

Mrs. DuMez was active in many local and national phar-
maceutical organizations.

She was honorary president of the Ladies Auxiliary of the
Maryland Pharmaceutical Association, the Women’s Auxiliary
of the American Pharmaceutical Association and the Alumni
Association of the University of Maryland School of Pharmacy.

For many years, Mrs. DuMez had led a dedicated personal
drive for support of the Hugh Mercer Apothecary Shop in Fred-
ericksburg, Virginia. She served on the board of managers of
Friends of Historical Pharmacy, Inc., which manages the opera-
tion of the ‘shop’, occupying the offices of first and second
vice president and president. She was honored with a plaque
and tribute at the Auxiliary brunch during the APhA Annual
Meeting in Houston in 1972. In his tribute to Mrs. DuMez, Dr.
Milton Neuroth, president of Friends of Historical Pharmacy,
said, “The years of devotion on the part of Mrs. DuMez to the
operation of the Hugh Mercer Apothecary Shop are a contribu-
tion of unusual significance to this shrine to American Pharmacy
and Medicine, and to the pleasure of tourists and visitors, in-
cluding the thousands of school children.”

Mrs. DuMez also had served on the APhA Auxiliary Board and
had been active in many Auxiliary activities.

Mrs. DuMez was a long time member of the American Insti-
tute of the History of Pharmacy. In her will, Mrs. DuMez left a
$5,000 bequest to the Institute. In 1972 she received a Certificate
of Commendation from the AIHP for “her efforts extending
over more than two decades to maintain the historic Hugh
Mercer Apothecary Shop.”

In addition, she held membership in the Camp and Hospital
Service of the American Red Cross, the Council of State Mental

34

Hospitals Association, the Women’s Club of Roland Park and
‘was past president of the Women’s City Club.

Mrs. DuMez also served as amember of the Maryland Coun-
cil of State Mental Hospital Auxiliaries and coordinator of volun-
teer services for Rosewood State Hospital.

She had moved to Rochester, Minnesota four years ago.

A graveside service was held February 11 at the Green Mount
Cemetery in Baltimore, where she was interred.

There are no survivors.

Israel (Doc) Baker, 74, graduate of University of Maryland
School of Pharmacy, at Washington Hospital Center, died
March 16.

Sister Mary Carmel Clarke, 77, retired chief pharmacist of Mercy
Hospital and 1934 graduate of the University of Maryland, died
March 17.

DEA Lists Procedure for Disposal
of Controlled Substances

The Drug Enforcement Administration (DEA) has reem-
phasized that a pharmacist wishing to dispose of any excess or
undesired stocks of controlled substances must contact the
nearest regional or district office of DEA and request Farm 41.
The regional director will authorize the pharmacist to use one of
the following means of disposal: (1) transfer to an authorized
registrant; (2) delivery to a DEA agent or to the nearest DEA

office; (3) destruction in the presence of a DEA agent or other

authorized person; or (4) any other means determined by the
regional director.

Institutional pharmacists are cautioned not to allow un-
wanted controlled drugs to accumulate in the pharmacy.

Court Upholds Ruling on Methadone

A federal Circuit Court upheld the decision of a lower court
that the FDA does not have authority to restrict the dispensing
of methadone for approved uses to certain types of pharmacies.
The FDA had proposed in 1972 that the dispensing of
methadone for analgesic use be restricted to hospital phar-
macies and a few community pharmacies in remote areas. Ina
challenge from the American Pharmaceutical Association, a
federal judge ruled that Congress had not given the FDA author-
ity to impose such a restriction. This ruling has now been up-
held.

When this regulation was proposed, the American Society of
Hospital Pharmacists submitted a statement objecting to the
withdrawal of methadone from pharmacies that do not dis-
pense it solely as part of an approved treatment program.

THE MARYLAND PHARMACIST

|

eS SS. Se TL

Big enough to
service you....

Small enough to
know you

Today...as always
...IN quality,
experience, reliability,
Paramount means
personal service and
personal contact!

2920 Greenmount Avenue
Baltimore, Maryland 21218

Phone: Baltimore — 366-1155; Washington (local call) 484-4050

MRR a i SS a aa a ee | ee
|

rows - FEBRUARY - MARCH, 1976 35

After 24 years...
onsider the

remarkable safety record

of Erythrocin

(ERYTHROMYCIN, ABBOTT)

tat

ERYTHROCIN'
Ethyl Succinate

- LIQUID-200

Erythrocin has never been shown to cause significant toxicity
to teeth, bone, blood, liver—or any other vital organ.

(While occasional abdominal discomfort and mild allergic reactions
may occur, serious allergic reactions have been notably infrequent.)

Brief Summary

Indications: Streptococcus pyogenes (Group A beta hemolytic
streptococcus)— Upper and lower respiratory tract infections, skin,
and soft tissue infections of mild to moderate severity. where oral
medication is preferred. Therapy should be continued for 10 days.

Alpha-hemolytic streptococci (viridans group)— Short-term pro-

phylaxis of bacterial endocarditis prior to dental or other operative
procedures in patients with a history of rheumatic fever or con-
genital heart disease who are hypersensitive to penicillin.

S. aureus — Acute infections of skin and soft tissue of mild to mod-
erate severity. Resistant organisms may emerge during treatment.
S. pneumoniae (D. pneumoniae)— Upper and lower respiratory
tract infections of mild to moderate degree.

M. pneumoniae —For respiratory infections due to this organism.
Hemophilus influenzae: For upper respiratory tract infections of
mild to moderate severity when used concomitantly with adequate
doses of sulfonamides. Not all strains of this organism are sus-
ceptible at the erythromycin concentrations ordinarily achieved
(see appropriate sulfonamide labeling for prescribing information).
Treponema pallidum—As an alternate treatment in patients
allergic to penicillin.

C. diphtheriae and C. minutissimum— As an adjunct to anti-
toxin. In the treatment of erythrasma.

Entamoeba histolytica —In the treatment of intestinal amebiasis.

L. monocytogenes — Infections due to this organism.

Establish susceptibility of pathogens to erythromycin, particularly
when S. aureus is isolated.

Contraindications: Known hypersensitivity to erythromycin,
Warnings: Safety for use in pregnancy has not been established.
Precautions: Exercise caution in administering to patients with
impaired hepatic function. Surgical procedures should be
performed when indicated.

Adverse Reactions: Dose-related abdominal cramping and dis-
comfort. Nausea, vomiting, and diarrhea infrequently occur. Dur-
ing prolonged or repeated therapy, there is a possibility of
overgrowth of non-susceptible bacteria or fungi. Mild allergic
reactions such as urticaria and other skin rashes may occur. Serious
allergic reactions, including anaphylaxis. have been reported.

Acompleteline
— backed by Abbott quality

In Tablets, 500 mg.. 250 mg. and 125 mg., in ready-
mixed Liquid forms, 200 mg. and 400 mg./5-ml. tsp..

| in Granules for Oral Suspension, 200 mg./5-ml. tsp.,

in Drops, 100 mg./2.5-ml. dropperful and in
200-mg. Chewable Tablets. Also in Supposi- Cc)

tories and in IM and IV forms. 6013107

Attend MPhA - TAMPA - LAMPA
94th Annual Convention
Sheraton Fontainebleau

Ocean City

June 20-23

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The most profitable 2:sq.ft.
in your store is now within reach.

Which of these two handsomely designed TROJAN counter display units is best for
your store? The modular plastic display provides moveable dividers to accommodate
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Please have your representative deliver and set up PHARMACY.
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THE MARYLAND PHARMACIST

650 WEST LOMBARD STREET
BALTIMORE MARYLAND 21201
TELEPHONE 301/727-0746

VOL. 52

CONTENTS

APRIL 1976

6 Editorial - Reluctant Partners: Government
and Pharmacy MPhA Response to MAC-EAC

8-9 Board of Trustees
10 MPhA 94th Annual Convention
Fifteenth Annual Robert L. Swain Pharmacy Seminar
14 MPhA Policy on Patient Medication Profiles
Institutional Pharmacy - Ophthalmic Drugs
for the Geriatric Patient
23. Maryland Board of Pharmacy
Alumni Association Dinner Meeting
27 Paul Reznek Honored by Maryland Senate
28 Reader’s Input
30 Obituaries
30 MPhA Calendar
31. MPhA Convention
32 MPhA Convention Reservation

INDEX TO ADVERTISERS

2 Calvert Drug 29 Maryland News Distributing Company
13 District Photo Uf Mayer & Steinberg, Inc.
15-16 Geigy Pharmaceuticals 26 Paramount Photo Service Company
3 Eli Lilly & Co., Inc. 31 Young Pharmaceuticals
4 Loewy Drug Co. 17 A. H. Robins Company

11 Smith, Kline and French Laboratories

Change of address may be made by sending old address (as it appears on
your journal) and new address with zip code number. Allow four weeks for
changeover. APhA members—please include APhA number.

The Maryland Pharmacist is published monthly by the Maryland Pharma-
ceutical Association, 650 W. Lombard Street, Baltimore, Md. 21201. Subscription
Price $5.00 a year. Entered as second class matter December 10, 1925, at the
Post Office at Baltimore, Maryland, under the Act of March 8, 1879.

NRE,

NATHAN I. GRUZ, Editor
PETER P. LAMY, PhD.,
Institutional Pharmacy Editor
MICHAEL J. SHIELDS, JR..,
Assistant Editor

ROSS P. CAMPBELL,

News Photographer
HERMAN BLOOM,
Photographer

OFFICERS & BOARD OF TRUSTEES
1975-1976

Honorary President

FRANK BLOCK

President

HENRY G. SEIDMAN - Baltimore
President Elect

MELVIN N. RUBIN - Arbutus

Vice President

RICHARD D. PARKER - Kensington
Treasurer

MORRIS LINDENBAUM

5 Main St., Reisterstown, Md. 21136
Executive Director

NATHAN I. GRUZ

650 W. Lombard St., Baltimore, Md. 21201

PAUL FREIMAN, Chairman
Baltimore

S. BEN FRIEDMAN (1976)
Potomac

ROBERT J. MARTIN (1977)
LaVale

ROBERT E. SNYDER (1978)
Baltimore

JAMES W. TRUITT, JR. (1976)
Federalsburg

LEONARD J. DIMINO (1978)
Wheaton

STANLEY J. YAFFE (1977)
Odenton

EX-OFFICIO MEMBERS
WILLIAM J. KINNARD, JR. - Baltimore

HOUSE OF DELEGATES

Speaker

IRVIN KAMENETZ - Owings Mills
Vice Speaker

SAMUEL LICHTER - Randallstown
Secretary

NATHAN I. GRUZ - Baltimore

MARYLAND BOARD OF PHARMACY
President

MORRIS R. YAFFE - Potomac
CHARLES H. TREGOE - Parkton

I. EARL KERPELMAN - Salisbury
RALPH T. QUARLES, SR. - Baltimore
Secretary

ROBERT E. SNYDER - Baltimore

editorial

RELUCTANT PARTNERS:
GOVERNMENT AND PHARMACY
MPhA RESPONSE TO MAC-EAC

Governmental involvement in health care to properly
secure more effective delivery of health services or to meet
unmet needs of people is understood and accepted by most
of us. But when laws and regulations result in onerous,
costly, time-consuming administrative burdens without
commensurate compensation to the professionals who
provide health services and products, then we must rebel in
our own enlightened self-interest. We must uncom-
promisingly proceed to secure redress of our grievances
using every possible lawful remedy — administrative,
legislative or through the courts if necessary.

Most important, both government and health care
providers must ask: how will the new governmental re-
quirements affect patient care?

The impact of the MAC-EAC (Maximum Allowable
Costs and Estimated Acquisition Costs) regulations based
on arbitrary federal requirements along with unrealistic,
unreasonable state implementation, if put into effect as
proposed, would have resulted in a decrease in the already
low, inequitable remuneration to pharmacists for dispensing
Medicaid prescriptions. The inevitable result would be fewer
pharmacies participating in Medicaid especially in many
areas where the poor and elderly reside in large numbers.

Fortunately, the Maryland Pharmaceutical Association
with the assistance of PHARMPAC — the political action
arm of pharmacy in Maryland — has been responsive to the
urgent needs of pharmacists. MPhA has been holding
almost weekly meetings with Medicaid officials. Special
legal counsel with particular expertise in administrative and
regulatory law has been retained to augment MPhA’s legal
counsel.

Results? We have concrete results!

First, implementation of MAC-EAC in Maryland has
been postponed.

Second, the State Medicaid Administration has agreed to
confer with MPhA Committee on Medicaid on all aspects of
Medicaid regulations and any proposals for change.

Third, price lists for computer input as price ceilings will
be reviewed by MPhA for validity, reasonableness and
whether up-to-date as to price changes.

Fourth, the state has agreed to conduct a survey of
prescription dispensing costs and to receive data from

6 THE MARYLAND PHARMACIST

MPhA. Medicaid staff has pledged its cooperation in
developing the information necessary to determine what is
an equitable prescription fee and to initiate appropriate
action based on relevant documentation.

The profession can be proud of the leadership of MPhA
officers, Board of Trustees and its Medicaid Committee in
achieving these results. It has been based upon the solid
support of a large percentage of pharmacists and of
management in all sectors of pharmacy.

Let us hope this evidence of cooperation and harmony will
prevail in meeting other problems we face now and in the
days ahead.

— Nathan I. Gruz

MAC/EAC
What You Can Do—Now!

The real significance of the final nature of
MAC/EAC regulations is the impact on the non-
governmental third party plans. As some form of NHI
(National Health Insurance) is inevitable within the
next few years, the pattern for Rx services reimburse-
ment will surely be influenced by the kind of policies
adopted today for Medicare and Medicaid.

Be wise — give your Association and your represen-
tatives who deal with government and third party
insurers the tools to work .. .

1. Make sure you and all your associates and staff
are paid up members of MPhA — so that we
speak on the basis of the largest possible number
of concerned persons. Are your suppliers and
their representatives sustaining, affiliate or
associate members?

. Make sure you have made your contribution to
PHARMPAC ~— the vital political action arm of
pharmacy. Many have already given generously.
Have you?

Make checks payable to: PHARMPAC. Mail to 650
W. Lombard St., Baltimore, Md. 21201

APRIL 1976

ae sro aemapancengeatatetnaaatndonentenesscmtocsttnanetienan

ty stngetneecsennanenttrtnamte niece ieeatentncee

MPHA
DIVIDEND CHECKS!

As a participating member in the MPhA
Workmen’s Compensation Program,
you Can receive a return of the profits

derived from your annual
premium. Every year! Up to 35%!
Interested? Ask Us!
This plan underwritten by A. D. |.

Your American Druggists’ Insurance Co. Representative

Ad] MAYER ” STEINBERG"
AND

SS 1101 N. CALVERT ST. ¢ BALTIMORE, MARYLAND 21202
General Insurance Agents and Brokers

(301) 752-7311

board
of trustees

MARYLAND PHARMACEUTICAL
ASSOCIATION MINUTES OF THE
BOARD OF TRUSTEES

Kelly Memorial Building
April 1, 1976

The meeting was called to order at the Kelly Memorial
Building by Chairman Freiman at 11:00 P.M.

Communications received included:

e Letter from Governor Mandel to Director Gruz in
response to recommendations on Medicaid Cost Contain-
ment;

e Letter from Dr. A. M. McConehey notifying us of death
of Mrs. Andrew G. DuMex, widow of the late Dean DuMez;
and

e Letter of resignation from Trustee Rudolph Winternitz
because of conflict in schedule. The resignation was accepted
by the Board with regrets.

e President’s Report — President Seidman suggested a
different format for Board meetings in the future in
Annapolis. Reported on his attendance at the Anne Arundel
County Pharmaceutical Association Installation meeting
and his address to a general meeting of the group. He also
met with the President of MSHP. He announced the
appointment of a School of Pharmacy Committee. The
Board approved the appointments subject to acceptance by
appointees. Normand Pelissier was recommended to replace
Mary Connelly who resigned from the Tripartite Committee
because of inability to attend. The appointment was
approved.

e Treasurer's Report — The Treasurer’s report was
presented and accepted. Dues for the 1976 year are running
ahead of the previous year.

e Executive Director’s Report — The priority was
legislative activity including meetings, hearings in An-
napolis and legislative contacts. Activities included: installa-
tion of the officers at the Anne Arundel County Phar-
maceutical Association annual meeting; the BMPA meeting
on Medicaid and HMO’s and the BUST program;
Membership/ Convention committees; NARD legislative
conference with the highlight being open forum with HEW
officials concerned with the MAC program; along with Mr.
Rubin, conferred with Dr. Apple at APhA on MAC. Mr.
Gruz was invited by PMA to attend a conference at
Burroughs Wellcome in North Carolina on Industry-
Pharmacy Relations. Contacted by the Maryland Nurses
Association regarding problems with Baltimore City Health

8 THE MARYLAND PHARMACIST

Department and reconstitution of drugs. Received copy of
letter from Attorney General’s office to Board of Pharmacy
Secretary Tregoe emphasizing that the prohibition of
prescription advertising is still in effect in Maryland and
compliance was required.

e The paid up membership is 136 ahead of the previous
year.

e Convention and Trips — The status of the San
Francisco/Las Vegas Seminar Tour was reported on. Work
is proceeding on the 1976 Convention and sites for 1977 in
Ocean City and Tamiment are being considered.

e Legislative Committee Report — Chairman Richard
Parker reported on the status of bills which had been
presented at the Legislative Committee prior to the Board of
Trustees meeting. HB 1306 on Continuing Education —
amendments were being sought to make the effective date
July 1, 1977. Qualifying amendment will also be offered on
HB 1291 to permit copies to be transmitted between
pharmacists.

@ School of Pharmacy Report — Dean Kinnard reported
that a major planning process was launched in light of the
Millis Report. There is a mandate from the University to set
up management procedures and identifying the lowest 10%
of priority because of budget problems. Donald Fedder has
been appointed as Co-ordinator of Community Pharmacy
of programs expanding his time from one-half to three-
quarters time. There will be a placement service for
pharmacists. Mr. Fedder will set up an intradisciplinary
course in Orthotics. There will be a new program in adult
primary health care on the campus involving all of the
schools. Dr. David Knapp was appointed to the Maryland
Medical Assistance Advisory Committee. Secretary of
Health Neil Solomon has been asked to set up a Commission
to study pharmacy in state hospitals. The Dean assumes the
Presidency of AACP in July. He pointed to the need for
work in APhA-AACP relations. He also requested input
from Trustees for consideration by AACP.

¢ HMOs — Mr. Rubin moved that MPhA represen-
tatives meet with the Maryland Senators and Congressman
to secure assistance for freedom of choice of pharmacy in
HMOs. Seconded and passed.

APRIL 1976

e Medicaid Cost Containment and Medical Assistance Maryland Pharmaceutical Association.
Program — There was a discussion of the effects of 50¢ co-

ees William Barnett, Rockville, P S
pay and elimination of OTC drugs and of action by MPhA. om ockville, Peoples Drug #20

James Gundling, Crisfield, Kent Pharmacy
e MAC-EAC — The consensus was to seek a meeting Page pea

with state Medicaid officials, particularly Messrs. Kent and
Eshelman, regarding a procedure for the updating of prices Harvey Basik, Baltimore, Keystone Pharmacy
before implementation.

Gerard Eugene, Beltsville

Seymour Sattin, Hyattsville, University Drugs

¢ Board of Pharmacy — Mr. Snyder announced that the
Board was supporting the Patient Profiles bill and spoke of
the budgetary problems developing from Division of Drug
Control personnel no longer being available. There is no one
serving as Secretary of the Board.

Marvin Anshell, Baltimore, Crestlyn Pharmacy

e MPhA guidelines on Patient Profiles — On motion of
Mr. Seidman, duly seconded, the guidelines previously

CHANGE OF ADDRESS

distributed were approved as a standard of practice for When you move—
pharmacy in Maryland. Please inform this office four weeks in advance to avoid
undelivered issues.

¢ Poison Prevention Week — Mr. Gruz reported on the "The Maryland Pharmacist’ is not forwarded by the Post
plans for observance of Poison Prevention Week which ee or ne eee Soars: Hes
. “ ” : o insure delivery of ''The Marylan armacist'' and a
included APhA posters, “Mr Yuk” counter display, TV and mailukindlyanctifyathe toftice cwhen your plane eanGve
radio publicity. and state the effective date. APhA members—please in-

clude APhA number.
Thank you for your cooperation.

Nathan |. Gruz, Editor

Maryland Pharmacist
New Members 650 West Lombard Street
Baltimore, Maryland 2120]

¢ Meeting adjourned at 3:00 P.M.

The following is a list of the new members approved at the
March 4, 1976 meeting of the Board of Trustees of the

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APRIL 1976 THE MARYLAND PHARMACIST 9

MPhA To Hold 94th
Annual Convention
on June 20-23rd
in Ocean City

The 94th Annual Convention of the Maryland Phar-
maceutical Association will be held this year on Sunday,
June 20 through Wednesday, June 23 at the Sheraton
Fontainebleau, 10100 Ocean Highway (on the boardwalk) in
Ocean City, Maryland.

Co-sponsored by the Ladies and Travelers Auxiliaries of
the Maryland Pharmaceutical Association, the Convention
will open with a welcoming cocktail party and reception on
Sunday evening, June 20 at 9:30 p.m.

Monday morning, June 21 will be devoted to a General
Session of the MPhA from 9:00 a.m. to 11:00 a.m. consisting
of a meeting of the MPhA House of Delegates, officer’s
reports, and a report from the Maryland Board of Phar-
macy.

A Brunch, meeting, and Fashion Show will be held
simultaneously for LAMPA (the Ladies Auxiliary) from
10:00 a.m. to 12:30 p.m.

TAMPA (the Travelers Auxiliary) of the MPhA will also
be holding their annual meeting from 10:00 a.m. to 12:30
p.m.

At 12:30 p.m. on Monday afternoon a Bicentennial
Program will be presented for all on “The Apothecary and
Practice of Medicine in Colonial Times” featuring Morris L.
Cooper, Curator of the B. Olive Cole Pharmacy Museum in
the Kelly Memorial Building on the campus of the Universi-
ty of Maryland in Baltimore. In addition to his lecture, Mr.
Cooper will present a slide presentation depicting the early
practice of pharmacy in the United States.

Following Mr. Cooper’s program the remainder of the
day will be devoted to leisure time allowing the members to
take advantage of the numerous recreational facilities
available at special rates. In addition to the regular Ocean
City facilities and amusements, indoor-outdoor swimming
pools, tennis courts, sauna and exercise rooms will be
available. Special rates will also be available for those who
would like to spend the afternoon playing golf or deep sea
fishing. Arrangements have also been made by the Associa-
tion to sponsor daily supervised programs for the children of
attendees.

10 THE MARYLAND PHARMACIST

At 6:30 p.m. TAMPA will sponsor a “Crabfeast” and
Square Dance at the Berlin Fire Hall.

On Tuesday morning, June 22, the MPhA House of
Delegates will hold its second session starting at 9:00 a.m.
during which the assembly will conduct the election of
Nominees to the State Board of Pharmacy and the nomina-
tion of Officers and Trustees. This second and final session
of the House of Delegates will be followed by a Cocktail
Party at 6:00 p.m. after which there will be a banquet and
dance starting at 7:00 p.m.

The final day of the Convention, Wednesday, June 23 will
be devoted to the MPhA’s Continuing Education Program
which will be conducted from 9:00 a.m. until 12 noon. As
part of the Association’s program of Continuing Education
a seminar will be presented on “Understanding and Using
Bioavailability Information: An Action Seminar”. The
Seminar and workshops will be conducted by Richard A.
Penna, APhA Assistant Executive Director for Phar-
maceutical Affairs, and Dr. William F. McGhan, Executive
Secretary, APhA Academy of Pharmaceutical Sciences.

All MPhA members who are planning to attend this year’s
convention are urged to register and insure their reservations
early. Reservations can only be guaranteed if received by
Friday, June 4th.

All attendees for the educational, social, entertainment,
recreational and food functions must be registered.

The registration fees for this year’s convention are as
follows:

PACKAGE AND INDIVIDUAL CHARGES

Pharmacist Registration — $45.00

Ladies — $40.00

Sunday Cocktail Party — $10.00

Monday LAMPA Brunch — $7.00

Monday Crabfeast and Dance — $10.00

Children’s Crabfeast — $3.50

Non-pharmacist Registration without C.E. programs —
$35.00

Tuesday Reception, Banquet and Dance — $20.00
Wednesday Continuing Education Program — $10.00
Children’s Banquet — $8.50

Pharmacy Students — $20.00

All checks for registration should be made payable to the
Maryland Pharmaceutical Association, 650 West Lombard
Street, Baltimore, Maryland 21201.

Remember to register early because accommodations will
be limited. Reservations can only be guaranteed if received
by Friday, June 4th.

APRIL 1976

~

, DENNIS CRAWFORD
RAY HECKMAN

DEAN SULLIVAN

b thom Q ‘8
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JOHN O'MALLEY

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TIM BRODERICK

ANNUAL ROBERT L. SWAIN
PHARMACY SEMINAR

The Maryland Pharmaceutical Association sponsored the
Fifteenth Annual Robert L. Swain Pharmacy Seminar as
part of its Continuing Education Program on Thursday,
March 18, 1976 at the Quality Inn, Towson, Maryland.

The seminar, which was chaired by Dr. C. Jelleff Carr,
was conducted from 8:30 a.m. to 4:30 p.m. and covered a
wide range of topics in several areas of pharmaceutical
interest.

Dr. Maven J. Myers, Professor of Pharmacy Administra-
tion at the Philadelphia College of Pharmacy and Science,
discussed the role and ramifications of proper administrative
procedures in “Patient Medication Records — An Over-
view”. Dr. George F. Archambault, Pharmacy and Drug
Distribution Systems, and former Pharmacy Liaison Officer
with the Office of the Surgeon General, United States Public
Health Service, lectured on the “Legal Aspects and Impacts”
of the pharmaceutical profession.

Dr. Ronald Goldner, a practicing dermatologist, ad-
dressed the assembly on the dangers and diversities of
patient reactions with his lecture on the “Allergic Responses
to Drugs”.

A luncheon followed with an interesting discussion by Dr.
John C. Krantz, Jr., Professor Emeritus of Pharmacology at
the University of Maryland School of Medicine, who
outlined briefly his “Bicentennial Observations on the
History of Pharmacy”. Dr. Krantz’s observations were
complemented by the showing of a documentary film
entitled: “The Heartbeat of the People — William Withering
and Digitalis”. Dr. Krantz served as Executive Producer of
the film.

The remainder of the seminar was devoted to a panel and
open discussion on “The Pharmacist’s Responsibilities in
Patient Information”. Donald O. Fedder, Coordinator of
Community Pharmacy Programs and Instructor at the
University of Maryland School of Pharmacy, served as
moderator of the discussion. Among the panelists were Paul
Freiman, community practice; Max Ray, Pharm. D.,
Director of Clinical Services, American Society of Hospital
Pharmacists; Emanuel Richman, Professional Services,
Giant Food Pharmacies. Also participating were Dr. Maven
J. Myers, Dr. George F. Archambault, and Dr. Ronald
Goldner.

Serving on the Seminar Committee in addition to Dr.
Carr were Philip H. Cogan, Paul Freiman, Sol Rosenstein,
Henry G. Seidman, Ralph F. Shangraw, PhD., Laura
Tepper, Henry Verhulst, and Nathan Gruz.

12 THE MARYLAND PHARMACIST

Seminar Speaker Dr. George F. Archambault (right) with Henry G.
Seidman, President of MPhA and Director of Continuing Education at the
U. of Md. School of Pharmacy.

Lecturer Dr. John C. Krantz, Jr. (left) with MPhA Executive Director
Nathan I. Gruz.

APRIL 1976

ten Ey

A historic photo at the Swain Seminar — left to
right: Dr. James C. Munch, internationally
renowned pharmacologist, now retired, with Dr.
John C. Krantz, Jr. (center) and Dr. C. Jelleff
Carr, Seminar Chairman. Krantz and Carr
authored the classic text, “Pharmacologic Prin-
ciples and Medical Practice.))

(TY INN
TOWSON...

au z3
Seminar Panelists: (left to right) Dr. Max Ray,
Donald O. Fedder (Moderator), Emanuel
Richman and Paul Freiman.

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APRIL 1976 THE MARYLAND PHARMACIST

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13

MPhA POLICY ON PATIENT
MEDICATION PROFILES

(Adopted by Board of Trustees March 4, 1976)

Definition

The Patient Medication Proile is a record of information
relating to a patient’s drug therapy. This profile contributes
to better health care by enhancing the ability of the
pharmacist to efficiently perform his professional duties.

Purposes

The Patient Medication Profile has, but is not limited to,
the following purposes:

1. To provide a medication history on the patient.

2. To provide information regarding the patient’s drug
utilization, including over-utilization and under-
utilization.

3. To provide data to facilitate patient consultation and
communication with other health professionals, when
the pharmacist has been advised of information related
to:

a. Arecord of patient drug allergies, previous idiosyn-
cratic responses and/or other untoward drug
effects.

b. An record of previously administered drugs which
have not been effective.

c. Data which will enable the prevention and/or
management of drug interactions.

Essential Information

The Patient Medication Profile must include, but is not
limited, to the following essential information:

1. Name of patient, 2. Address of patient, 3. Telephone
number of patient, 4. Indication of age grouping to include
date of birth if under 16 years old or over 65 years old, 5.
Prescription number, 6. Date of Service, 7. Drug product
name and manufacturer, if appropriate, 8. Dosage form, 9.
Strength, 10. Quantity dispensed, 11. Name of prescriber
and 12. Initials of pharmacist unless indicated on original
Rx.

Patient Profile should also include the following when the
pharmacist has been advised of information related to:

1. Previous drug allergies, idiosyncratic reactions and/or
untoward drug effects,

2. Disease conditions of the patient,

. Previous ineffective therapy,

4. Non-prescription medication utilized by the patient.

WwW

Implementation and Utilization

1. Patient History — The pharmacist should establish a |

method for gathering and recording essential patient
information. The preferred method of gathering infor-
mation is a personal interview.

2. Family Profile — While an individual patient profile
may be more efficiently utilized, a single profile may be
kept for an entire family living in one household
provided adequate means are available to readily
identify which medication was prescribed for each
family member.

3. Profile Utilization — The Patient Medication Profile
must be examined by the pharmacist each time a
service is performed. A warning system to easily
identify a patient as having problems requiring par-
ticular attention should be incorporated. Any incon-
sistency or potential problem detected must be resolved
by appropriate action.

4. Confidentiality — The Patient Medication Profile
must be afforded the same status of confidentiality as is
the prescription order.

5. Communicating the Value — The pharmacist should
familiarize the patient and other health care
professionals with the benefits that can accrue to the
patient through the proper utilization of the Patient
Medication Profile.

Practice Management Aspects

The Patient Medication Profile may contain additional
features which will aid the pharmacist in the efficient
management of his practice. Some examples are:

. Third party payment information

. Generation of tax and insurance receipts

. Identification of prescription order by patient’s name
Simultaneous production of prescription label

. Accounting and billing information

. Delivery instructions

. Non-health related information about the patient

8. Inventory control

Conclusion

The Patient Medication Profile is an integral component
of pharmaceutical service. It isa dynamic tool in the delivery
of service, not merely a stagnant record. The profile has
become an indispensible aid for pharmacists in their
interaction with patients and other health professionals. The
increasing trend to multi-disciplinary involvement in health
care delivery has placed added emphasis on the use of
Patient Medication Profiles by the pharmacist. The infor-
mation contained in the profile expands the pharmacist’s
capability to utilize his knowledge, experience and
professional judgement in making a significant contribution
to patient care.

14

(Adapted with additions from A PhA Academy of Pharmacy
Practice Statement on Patient Medication Profiles.)

THE MARYLAND PHARMACIST

APRIL 1976

|
|
|

|

Bronchodilator tablets

RE | Al

eroutaline sulfate

Highly effective oral bronchodilator.
Minimal cardiac effect.
Side effects are generally transient.

Effectiveness lasts from four to eight
hours.

Effective for long-term treatment.
Only three tablets a day.

Please see full prescribing information on the back of this page.

™

Brethine™
brand of terbutaline sulfate

Tablets of 5 mg.
Prescribing Information

Description Brethine, brand of terbutaline sul-
fate, asynthetic sympathomimetic amine, may be
chemically described as w-[(tert-butylamino)
methyl|]-3,5-dihydroxybenzyl alcohol sulfate. The
structural formula is as follows:

| ( CHCH,NHC(CH3)5
\ fa

—— OH
HO

Brethine, brand of terbutaline sulfate, is a water
soluble, colorless, crystalline solid. Tablets con-
taining Brethine, brand of terbutaline sulfate,
should be stored at controlled room temperature.

*H,SO,

2

Each scored, white tablet contains 5 mg. (equiv-
alent to 4.1 mg. of free base) of Brethine, brand
of terbutaline sulfate

Actions Brethine, brand of terbutaline sulfate, is
a B-adrenergic receptor agonist which has been
shown by in vitro and in vivo pharmacological
studies in animals to exert a preferential effect
on B, adrenergic receptors such as those located
in bronchial smooth muscle. Controlled clinical
studies in patients who were administered the
drug orally have revealed proportionally greater
changes in pulmonary function parameters than
in heart rate or blood pressure. While this sug-
gests a relative preference for the 8, receptor in
man, the usual cardiovascular effects commonly
associated with sympathomimetic agents were
also observed with Brethine, brand of terbuta-
line sulfate

Brethine, brand of terbutaline sulfate, has been
shown in controlled clinical studies to relieve
bronchospasm in chronic obstructive pulmon-
ary disease

This action is manifested by a Clinically signifi-
cant increase in pulmonary function as demon-
strated by an increase of 15% or more in FEV,
and in FEF 2.7, . Following administration of
Brethine, brand of terbutaline sulfate, tablets, a
measurable change in flow rate is usually ob-

Brethine” Tablets

terbutaline sulfate

Geigy

An oral bronchodilator for patients
with bronchial asthma and reversible
bronchospasm associated with
bronchitis and emphysema.

served in 30 minutes, and a Clinically significant
improvement in pulmonary function occurs at
60-120 minutes. The maximum effect usually oc-
curs within 120-180 minutes. Brethine, brand of
terbutaline sulfate, also produces a Clinically
significant decrease in airway and pulmonary
resistance which persists for at least four hours
or longer. Significant bronchodilator action, as
measured by various pulmonary function deter-
minations (airway resistance, FEFos.75%, Or
PEFR), has been demonstrated in some studies
for periods up to eight hours.

Clinical studies were conducted in which the
effectiveness of Brethine, brand of terbutaline
sulfate, was evaluated in comparison with ephe-
drine over periods up to three months. Both
drugs continued to produce significant improve-
ment in pulmonary function throughout this
period of treatment.

Indications Brethine, brand of terbutaline sulfate,
is indicated as a bronchodilator for bronchial
asthma and for reversible bronchospasm which
may occur in association with bronchitis and
emphysema.

Contraindications Brethine, brand of terbuta-
line sulfate, is contraindicated when there is
known hypersensitivity to sympathomimetic
amines.

Warnings Usage in Pregnancy: Animal repro-
ductive studies have been negative with respect
to adverse effects on fetal development. The safe
use of Brethine, brand of terbutaline sulfate, has
not, however, been established in human preg-
nancy. As with any medication, the use of the
drug in pregnancy, lactation, or women of child-
bearing potential requires that the expected thera-
peutic benefit of the drug be weighed against

its possible hazards to the mother or child

Usage in Pediatrics: Brethine, brand of terbuta-
line sulfate, tablets are not presently recom-
mended for children below the age of 12 years
due to insufficient clinical data in this pediatric

group.

Precautions Brethine, brand of terbutaline sul-
fate, should be used with caution in patients
with diabetes, hypertension, and hyperthyroidism.

As with other sympathomimetic bronchodilator
agents, Brethine, brand of terbutaline sulfate,
should be administered cautiously to cardiac
patients, especially those with associated
arrhythmias.

The concomitant use of Brethine, brand of ter-
butaline sulfate, with other sympathomimetic
agents is not recommended, since their com-
bined effect on the cardiovascular system may

be deleterious to the patient. However, this does
not preclude the use of an aerosol bronchodila-
tor of the adrenergic stimulant type for the re-
lief of an acute bronchospasm in patients receiv-
ing chronic oral Brethine, brand of terbutaline
sulfate, therapy.

Adverse Reactions Commonly observed side
effects include nervousness and tremor. Other
reported reactions include headache, increased
heart rate, palpitations, drowsiness, nausea, vomit-
ing, and sweating. These reactions are generally
transient in nature and usually do not require
treatment. The frequency of these side effects
appears to diminish with continued therapy. In
general, all the side effects observed are charac-
teristic of those commonly seen with sympa-
thomimetic amines.

Dosage and Administration The usual oral dose
of Brethine, brand of terbutaline sulfate, for
adults is 5 mg. administered at approximately
six-hour intervals, three times dally, during the
hours the patient is usually awake. If side effects
are particularly disturbing, the dose may be re-
duced to 2.5 mg., three times daily, and still pro-
vide a Clinically significant improvement in pul-
monary function. A dose of 2.5 mg., three times
daily, also is recommended for children in the 12-
to 15-year group. Brethine, brand of terbutaline
sulfate, is not recommended at present for use
in children below the age of 12 years. In adults, a
total dose of 15 mg. should not be exceeded ina
24-hour period. In children, a total dose of 7.5
mg. should not be exceeded in a 24-hour period.

How Supplied Brethine, brand of terbutaline
sulfate, tablets of 5 mg. are supplied in bottles
of 100. 98-146-060-B (5/75) 667001

Distributed by:

GEIGY Pharmaceuticals

Division of CIBA-GEIGY Corporation
Ardsley, New York 10502

BR 11331

a Allbee witnC oo
MULTIVITAMINS

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sale 4 fiacin 50 mg %
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institutional
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18

Ophthalmic Drugs for the Geriatric Patient

BERRY J. MEANS and PETER P. LAMY, Ph.D.,” Baltimore, Maryland

Reprinted with permission from
“Clinical Medicine”, October 1975

ee ee
C1 Older patients often have unique eye problems for
which ophthalmic drops are frequently indicated. How-
ever, the physician must use caution in prescribing these
drugs because of possible adverse effects. I

As one becomes older, certain changes take place in
the eye. Streiff refers to two different types of changes. | t
The normal physiologic processes which are inevitable in
old age are gerontologic changes, while changes due to
pathologic processes are geriatric. According to Bell,
structural and functional changes in the eye can be divid-
ed into two categories:* (1) Those involving mechanical
aspects of the lens, which begin at age 40 and deal with
physical aspects of the diopteric media. These changes
cause slow accommodation, less tolerance to glare, anda
decrease in the amount of light that enters the eye. (2)
Those involving the retina and metabolic system. These
changes usually start at around age 60 and are thought
to be due to decreased oxygen supply, neuronal death,
or both. These latter changes cause loss of the visual
field, delayed adaptation to darkness, and other
problems.

The tissue of the eyelids and surrounding area under-
goes changes with age mainly because of dehydration of
the skin and ocular muscles, atrophy of fat tissue, and a
loss of skin elasticity and fibrous tissue. The skin of the
lids wrinkles, leading to the ‘‘baggy’’ eyes so common in
older people. The lower lid may fall away from the eye-

*Mr. Means is a Drug Information Pharmacist at the Johns
Hopkins Hospital, Pharmacy Dept. When the paper was
written, he was a Graduate Student in the Institutional
Pharmacy Programs, University of Maryland. Dr. Lamy
is Professor of Pharmacy and Director, Institutional
Pharmacy Programs, School of Pharmacy/University of
Maryland Hospital, University of Maryland.

t Bibliography supplied on request.

THE MARYLAND PHARMACIST

ball (senile ectropion), leaving it unprotected and allow-
ing tears to accumulate. The eyelashes may turn in
toward the cornea (senile entropion), causing irritation.

The corneal endothelium can undergo degenerative
changes.° Degenerated endothelium can become edema-
tous decreasing the optical efficiency of the cornea.

This usually shows up in the morning after sleep and is
dispersed as the day passes by the blinking of the eye. As
one ages, the cornea increases its curvature, producing
astigmatism, and may also be partially circumscribed by
fat deposits producing a condition known as arcus
senilis.1°°

The corneoscleral trabeculae become denser owing to
tissue sclerosis and hyalinization, thus reducing the iri-
docorneal angle and increasing the resistance to the out-
flow of aqueous humor.’

The vitreous body changes with age.* Two of the
most common symptoms resulting from these changes
are ‘‘floaters,’’ or floating bodies which the patient sees
when looking at a bright field or a light surface, and
photopsia or light flashes observed when the eyes are
moved while the lids are closed. The ‘’floaters’’ referred
to as muscae volitantes are from fine fibers or cellular
aggregates that become more visible as the vitrous gel
liquefies. Vitreous detachment may accompany this age-
induced liquefaction of the vitreous body. The photop-
sia are thought to be caused by traction as the contract-
ing vitreous body pulls away from the retina.

The part of the eye displaying the most obvious
changes due to age is the lens.°’® The lens continues to
grow throughout life; new fibers are formed and super-
imposed on the old, which become smaller, dehydrated,
more dense, and less flexible. Eventually the lens be-
comes so hard and inflexible that it is limited in its ability
to accommodate (focus objects clearly on the retina),
and corrective lenses are required. The lens becomes less
transparent, resulting in a decreased amount of light
that reaches the retina.’ Lessening in lens clarity is refer-

APRIL 1976

APRIL 1976

red to as a cataract. Cataracts are the most common dis-
ability in the aged eye.®:?

In fact, Beehler states that the nature of the lens is
such that everyone would experience cataracts given a
long enough life-span.'° These cataracts can be ascribed
to physiologic causes associated with the gradual loss of
transparency due to increased numbers of dense fibers,
or to pathologic causes. The etiology of pathologic
cataracts is not completely understood.° There is some
evidence, however, implicating certain drugs and specifi-
cally certain eye drops in the formation of lens opaci-
ties.) 1912

... the cataractogenic properties of
steroids appear to be age - and dose-
reldied =.

Among the systemic drugs implicated in cataracts men-
tioned by Paterson are the corticosteroids and pheno-
thiazines.'* The lens opacities associated with steroid
therapy start in the posterior subcapsulary region and
are referred to as posterior subcapsulary cataracts
(PSCC). As the cataracts progress they move toward the
outside of the lens and eventually merge to form a con-
glomerate. Although PSCC are not only caused by
steroids, there is a higher incidence in the older patient
and especially in patients on long-term corticosteroid
therapy. Spaeth and von Sallmann, who compiled re-
ports on 693 patients treated with systemic steroids,
found 21 percent with lens changes, compared to an
approximate PSCC incidence of 0.2 percent in the
general population.!?:!% Several studies have suggested
that the cataractogenic properties of steroids are dose-
related.'* !®© PSCC did not develop when patients were
treated with less than 10 mg. of prednisone per day, but
did develop in about 75 percent of those receiving over
16 mg. of prednisone ailyenae ac Paterson does not say
whether different corticosteroids possess different de-
grees of cataractogenicity.' 2 It would be safe to say
that the cataractogenic properties of steroids are age- and

dose-related.

Chlorpromazine causes lens changes in patients who
have received the drug for long periods of Cine ees
little as 300 mg. chlorpromazine daily for several years
may cause these changes, and in patients taking a total
dose of 250 Gm. there is an incidence of lens changes of
about 90 percent.!*!° Other phenothiazines may also
cause lens opacities.*°

Macular degeneration is the cause of many visual

problems in the aged, affecting about 30 percent of the
elderly over age 65.” Since the macula is that part of the
retina responsible for visual acuity, these older persons
complain of an inability to read or recognize faces, while
peripheral vision is relatively unaffected.?°>'?! This
condition could be caused by diseases such as diabetes.

Glaucoma is the second most important eye problem
in the elderly. Different studies report the prevalence of
glaucoma in persons over age 40 to be from 0.65 to nine
percent.-2— 7° Pollack points out that the differences in
reported prevalence of glaucoma may be owing to differ-
ences in methods of examination and data analysis;
population bias; and, most importantly, the lack of a
uniform definition of glaucoma.*” Since the diagnosis
of glaucoma was formerly based more on ocular hyper-
tension than on the disc and field changes that have been
emphasized more recently, the true prevalence of glau-
coma most likely falls at the lower end of the range of
reported prevalence. Glaucoma is classified into two
basic types—narrow angle and chronic simple or open
angle. The two types are similar only in that they cause
elevated intraocular pressure.

Normally, intraocular pressure remains constant due
to a decrease in aqueous humor production that matches
the increased resistance to flow from the anterior
chamber.° When the resistance increases to the point
that the intraocular pressure rises above normal levels,
however, the person is said to have open angle glaucoma.
The acute closed angle type of glaucoma appears to
occur only in persons anatomically predisposed to the
condition by the shallow anterior chamber, especially
those with hyperopia (far-sightedness). Narrow angle
glaucoma may be more prevalent in persons from the
fifth decade onward due to the increasing size of the
lens, which continues to grow throughout life, decreasing
the depth of the anterior chamber.2” The increased intra-
ocular pressure associated with both types of glaucoma
causes a cupping and atrophy of the optic nerve, result-
ing in progressive, irreversible loss of peripheral vision.

There are reports of various drugs adversely affecting
the patient's eye by increasing intraocular pressure. The
package insert of many drugs cautions the physician
about prescribing them for patients with glaucoma.” ”
Among these are the anticholinergic and sympatho-
mimetic drugs. Willetts and Hopkins and Lund state that
the danger of using these drugs is most significant in per-
sons with a narrow anterior chamber irrespective of the
presence of glaucoma.?®*?? Lund feels that the risk to
the patient with a narrow anterior chamber is propor-
tional to the dilating effect of the drug.2? Lazenby
et al. studied the effect of 0.6 mg. of atropine three

THE MARYLAND PHARMACIST

Generic Name

Amitriptyline

Amphetamine

Amyl nitrite
Anisotropine
Atropine
Belladonna

Benzphetamine

Benztropine

Biperiden

Carbamazepine

Chlorphenoxamine

Chlorphentermine

Chlorprothixene

Cycrimine

Cyproheptadine

TABLE 1
DRUGS LABELED AS CONTRAINDICATED OR TO BE USED WITH CAUTION IN GLAUCOMA”

Comment

Contraindicated

Contraindicated, especially
in narrow angle

Use with caution

Generally contraindicated
Generally contraindicated
Generally contraindicated

Contraindicated, especially
in narrow angle

May cause or aggravate
glaucoma

Use with caution

Closely observe patient
with increased ocular
tension

Use with caution

Contraindicated, especially
in narrow angle

Has anticholinergic
properties

Contraindicated

Weak, peripheral anti-
cholinergic action

Generic Name

Desipramine

Dextroamphetamine

Diethylpropion

Dimethindene

Diphemanil
Diphenidol
Doxepin

Erythrityle
tetranitrate

Ethopropazine
Flavoxate

F luphenazine
Glycopyrrolate
Hexocyclium

Homatropine
Imipramine

lsocarboxazid

Comment

Use with caution

Contraindicated, especially
in narrow angle

Possibly contraindicated,
especially in narrow
angle

Tertiary amine with action
similar to tertiary amine
anticholinergic

Generally contraindicated
Use with caution

Contraindicated

Use with caution

Use with caution
Increases ocular tension
May cause glaucoma

Use with caution
Generally contraindicated

Generally contraindicated

Use with caution

May aggravate

(Continued on next page)

times a day for seven days on patients with chronic open
angle glaucoma.°” The authors concluded that while one
should be cautious in the repeated systemic administra-
tion of anticholinergics to patients with open angle
glaucoma, significant increases in intraocular pressure
are likely to occur in only a small minority of patients.
Some of the psychotropic drugs (e.g., the tricyclic
antidepressants and phenothiazines) are thought to have
anticholinergic properties. Lund, however, found psycho-
tropic-induced glaucoma extremely rare.7? The topical
vasoconstrictors (e.g., phenylephrine and tetrahydrozo-
line) are to be used with caution in patients with narrow
angle glaucoma. Drugs commonly used to treat parkin-
sonism, a condition common in older persons, have anti-

* Compiled from the American Hospital Formulary Service,
American Society of Hospital Pharmacists.

THE MARYLAND PHARMACIST

cholinergic properties and also bear the recommendation
that they must be used with caution in patients with
glaucoma. Table 1 lists drugs that are labeled as being
contraindicated or to be used with caution in glau-
coma. This is not meant to be an all-inclusive list. In the
patient with open angle glaucoma, however, the danger of
these drugs increasing intraocular pressure is doubtful.
Keratitis sicca (dry eye), a problem of the older pa-
tient, appears to be more common than formerly sus-
pected.>!3? The patient frequently complains of a burn-
ing sensation or sandy feeling in the eyes. The extent of
tear production can be estimated by the Schirmer test.
While persons of all ages are susceptible to inflamma-
tion of the eyes, certain conditions may be more familiar
in the geriatric patient. The corners of the eye (canthi)
in the older patient are particularly prone to infection.

APRIL 1976

Generic Name

lsopropamide

|sosorbide
dinitrate

Levodopa

Mepenzolate

Methamphetamine

Methantheline
Methixene
Methscopolamine
Methylatropine
Methylphenidate
Nialamide
Nitroglycerine
Nortriptyline
Orphenadrine
Oxyphencyclimine
Oxyphenonium
Papverine

Pentapiperide

TABLE 1 (continued)

Comment

Contraindicated

Use with caution

Contraindicated in narrow
angle; supervise use in
wide angle

Generally contraindicated

Contraindicated, especially
in narrow angle

Contraindicated
Use with caution
Contraindicated
Generally contraindicated
Contraindicated
May aggravate
Use with caution
Use with caution
Contraindicated
Contraindicated
Contraindicated
Use with caution

Contraindicated

Generic Name

Pentaerythritol
tetranitrate
Penthienate

Phendimetrazine

Phenelzine
Phenmetrazine
Phentermine
Pipenzolate
Piperidolate
Poldine
Procyclidine
Propantheline
Protriptyline
Tricyclamol
Tridihexethy|
Trihexyphenidy!|
Triprolidine

Trolnitrate

Comment

Use with caution

Generally contraindicated

Contraindicated, especially
in narrow angle

May aggravate

Possibly contraindicated
Possibly contraindicated
Generally contraindicated
Use with caution
Generally contraindicated
Use with caution
Contraindicated
Contraindicated
Generally contraindicated
Contraindicated

Use with caution

Tertiary amine with action
similar to tertiary amine
anticholinergic

Use with caution.

APRIL 1976

Wrinkled and loose skin has a tendency to retain tears,
which then provide an ideal site for an infection to
starts’

Another area of concern is exemplified by a report of
an epidemic of keratoconjunctivitis epidemica in a home
for the aged.** One patient with the disease was tested
for increased intraocular pressure and the contaminated
instrument was subsequently used on other patients.

Treatment of Eye Problems in the Aged

The treatment of pathologic and physiologic ocular
conditions in the elderly is relatively specific. Cataracts
are a surgical problem, the indication for surgery being
based to a large extent on the degree of vision impair-
ment and needs of the patient. The use of new suturing
techniques, cryoextractors, and alpha-chymotrypsin

help to make this operation almost always safe and suc-
cessful.!°

Macular degeneration, which causes the older patient
to lose central visual acuity, cannot really be treated. The
patient is assured that he will not ‘‘go blind’ and en-
couraged to partake in activities that rely more on periph-
eral vision.

Glaucoma is one of the eye problems of older persons
that generally responds to drug therapy. The acute attack
of narrow angle glaucoma is treated with miotics and, if
necessary, systemic drugs (e.g., mannitol or urea) ad-
ministered intravenously or glycerine, 50 to 70 percent,
administered orally. These drugs lower intraocular pres-
sure by making the blood hyperosmolar in comparison
to the aqueous humor of the eye. The condition is

generally cured by surgery. The chronic open angle type

THE MARYLAND PHARMACIST

21

of glaucoma may be more dangerous than the acute type
due to its insidious nature.'°’*® Chronic open angle
glaucoma can usually be controlled by the use of opthal-
mic drops and the tendency is to delay surgery as long as
possible. *4

Cholinergics such as pilocarpine and carbachol have
been used to treat glaucoma. Pilocarpine is first tried in a
weak strength (0.5 percent) up to every six hours. The
strength may be increased until an adequate response is
obtained. Carbachol may be used as a substitute for pilo-
carpine in patients showing an allergy to the latter. These
cholinergic drugs facilitate the filtering of the aqueous
humor out of the anterior chamber through the trabec-
ular network. The specific manner in which these agents

do this is not understood.

... glaucoma 1s one eye problem
that usually responds to drug
therapy...

Epinephrine had fallen into disrepute owing to the
fact that it dilates the pupil and had precipitated attacks
of acute narrow angle glaucoma.”! Since it is now possi-
ble to differentiate between narrow and wide angle
glaucoma, epinephrine has once again become accepted
as a valuable drug in the treatment of glaucoma. It is
thought to have a dual mechanism of action: It decreases
production of aqueous humor and also increases the rate
of filtration of fluid out of the anterior chamber.°° It is
not uncommon to see pilocarpine and epinephrine used
concurrently in the treatment of glaucoma.

The organophosphate cholinesterase inhibitors are
also useful in the treatment of open angle glaucoma.
They frequently maintain normal intraocular pressure
when the more commonly used miotics have not been
successful. Echothiophate iodide is probably one of the
most well known preparations of this type.

Recently there has been concern about reports that
the cholinesterase inhibitors cause lens opacities./ 1:1?
Pietsch et al. demonstrated lens changes in 37 glaucoma
patients after only four months of echothiophate ther-
apy.!! Shaffer and Heatherington found that there was
approximately the same percentage of lens opacities
with isoflurophate, demercarium bromide, and echothio-
phate.?* The echothiophate package insert points out
that the cataractogenic properties of the drug apparently
are dose- and age-related, and selective in that some pa-

THE MARYLAND PHARMACIST

tients have not experienced lens opacities after many
years of therapy with the higher concentrations of the
drug. Harris studied the dose response of various concen-
trations of echothiophate from 0.03 to 0.25 percent.°°
He found that as the concentration exceeded 0.06 per-
cent, a large number of subjects complained of side ef-
fects (browache, dimness of vision, and blurring) and no
improvement in pressure or outflow was achieved. He
states that since there is evidence to indicate the catarac-
togenic properties of echothiophate are dose-dependent,
there is little rationale for using echothiophate in con-
centrations above 0.06 percent.°° On the other hand,
oral anticholinesterases do not appear to be particularly
cataractogenic.>”

Dry eye is a problem prevalent in the older patient
which may be treated with ophthalmic drops.°? Lemp
et al. describe the tear film as a three-part structure—a
thin, superficial lipid layer; a thicker aqueous layer; and
an innermost mucoid layer.2° The cornea itself is de-
scribed as a hydrophobic structure. The conjunctival
mucus produced in the conjunctival goblet cells and
mechanically spread on the cornea by blinking provides
a hydrophilic surface on which the tears spread. If this
mucous layer is not present the tear film breaks up pre-
maturely. Dry eye is thought to be due to two possible
causes—a decrease in amount of tear production or a de-
crease in the amount of mucus adsorbed on the cornea.
Many products have been promoted for the treatment of
dry eye. Among these are agents to increase tear viscos-
ity (e.g., methylcellulose) and agents to produce a film-
like corneal covering (e.g., polyviny! alcohol).°? Methyl-
cellulose is available in concentrations ranging from 0.5
to 5 percent, and polyviny! alcohol is used as a 1.4 per-
cent solution.

A disadvantage of methylcellulose is that as the sol-
vent evaporates, a flaky residue is left to combine with
any mucus that is present to cause a decrease in vision
and comfort, and patients may, therefore, prefer poly-
vinyl alcohol.*° Barsam and colleagues state that the
chief disadvantage of methylcellulose and polyviny!
alcohol is the short duration of action.*! Based on
Lemp’s mucoid theory of tear film, they used an ophthal-
mic solution prepared with a water-soluble polymer
having mucoid properties in 112 patients and concluded
that this mucoid-like polymer did prevent tear film
breakup longer than other agents.

Anti-infectives and/or anti-inflammatory drugs are
available as combinations in numerous products and
their use may possibly cause problems in the older pa-
tient. There are reports of topical steroids increasing

(continued on page 25)

APRIL 1976

|

maryland board

of elnarmnacy

The following are the pharmacy changes for the month of
February:

New Pharmacies

Dart Drug Corporation #234, Herbert Haft, President;
5100 Nicholson Lane, Rockville, Maryland 20852.

West Baltimore Community Health Care Corporation,
Thomas E. Waters, Project Director; 1701 West Pratt Street,
Baltimore, Maryland 21223.

Institutional Pharmacy Services, Inc., Gilbert Cohen,
President; 902 North Charles Street, Baltimore, Maryland
21201.

Dorchester General Hospital, Inc., Alfred R. Maryanov,
President; 300 Byrn Street, Cambridge, Maryland 21613.

Changes of Ownership, Address, Etc.
Bethesda Park Pharmacy, Eddie Wolfe (Change of

ownership—was: David C. Healy, President); 11125
Rockville Pike, Rockville, Maryland 20852.
Ingleside Pharmacy, Robert Rosenberg, President

(Change of ownership—was: Roger P. Potyk, President);

315 Ingleside Avenue, Baltimore, Maryland 21228.

No Longer Operating As Pharmacies

Peoples Service Drug Store #171, W. J. Johnson, Presi-

dent; 2011 Viers Mill Road, Rockville, Maryland 20851.

The following are the pharmacy changes for the month of

March:

New Pharmacies

K Mart Pharmacy #3229, E. E. Wardlow, President; 5100
Sinclair Lane, Baltimore, Maryland 21206.

Changes of Ownership, Address, Etc.

McAlpine Pharmacy, Daniel S. Shaner (Change of
ownership—was: Charles F. Young, President); 9141
Baltimore National Pike, Ellicott City, Maryland 21043.

MSJ, Inc., Philip Shermak (Change of ownership—was:
Solomon Winn, President) (Change of pharmacy name—
was: Winn’s Pharmacy); 2540 East Fayette Street,
Baltimore, Maryland 21224.

APRIL 1976

Exams scheduled for June 16-18

The Maryland Board of Pharmacy will conduct its 1976
annual examinations for state registration as a pharmacist
on Wednesday, Thursday, and Friday, June 16 through 18 at
the University of Maryland, School of Pharmacy, 636 West
Lombard Street, Baltimore, Maryland.

The examinations are scheduled to begin at 8:00 a.m. each
day.

All applications for the examination must be in the hands
of the Maryland Board of Pharmacy by Friday, June 4,
1976. The Maryland Board of Pharmacy is located at 210
West Preston Street, Baltimore, Maryland (Telephone: 383-
2729).

U. of Md. School of Pharmacy “PEP”
Seminar/Workshop

The University of Maryland School of Pharmacy spon-
sored a workshop for community and hospital Professional
Experience Program (PEP) preceptors, faculty members
and guests to demonstrate how to screen hypertension
patients. Approximately 50 people attended the workshop
from the Baltimore, Western Maryland, Eastern Shore, and
Virginia areas.

The Professional Experience Program is designed to give
fifth-year Pharmacy students the opportunity to work “in
the field” under the sponsorship of over 100 hospital and
community pharmacists.

Dr. Robert A. Kerr, David S. Roffman, and Robert J.
Michocki all of the University of Maryland’s Division of
Clinical Pharmacy, taught workshop participants how to
take a correct blood pressure and pulse.

Wendy Klein, Raymond Love, and Christine Bell, Pharm.
D. students; Donald Fedder of the school’s Pharmacy
Department; and Henry R. Seidman, Director of Con-
tinuing Education, also provided services at the workshop.

The Baltimore Chapter of the American Heart Associa-
tion provided the necessary equipment and the firm of
Merck, Sharpe and Dohme supplied the material needed to
conduct the tests.

Workshop participants were divided into small groups
and given pre-and post-tests based upon the correct systolic
and diastolic pressures taken. The average pre-test score was
36 (out of a possible 100) and the success of the workshop
can be demonstrated by the final post-test scores which ran
into the mid50’s. Of the 58% who said they knew how to take
blood pressures and check pulse rates, 94% said they had
learned new information at the workshop.

Continuing Education credits will be awarded those who
attended the seminar and workshop upon the successful
completion of a second June test.

THE MARYLAND PHARMACIST 23

BRIGGS HONORED
BY ALUMNI ASSOCIATION

The Alumni Association of the University of Maryland
School of Pharmacy hosted a Dinner Meeting at Martin’s
Caterers West on Sunday, March 21, 1976.

Henry G. Seidman, Vice President of the Alumni
Associaion, served as Chairman of the Dinner Program.
After the association members were greeted by Leon Weiner,
President of the Alumni Associaton, remarks were delivered
by Dr. William J. Kinnard, Jr., Dean of the University of
Maryland, School of Pharmacy; Dr. Albin O. Kuhn,
Chancellor of the University of Maryland at Baltimore; and
Colonel J. Logan Schutz, Director of the Alumni Affairs for
the University of Maryland.

Following a cocktail hour and gourmet dinner, Dr. W.
Paul Briggs was awarded the Honorary President’s Plaque
of the University of Maryland School of Pharmacy Alumni
Association in recognition of his services and contributions
to the profession of pharmacy.

A registered pharmacist since 1934, Dr. Briggs is a
nationally known pharmacist, educator, writer, and ad-
ministrator. A former Executive Director of the American
Foundation for Pharmaceutical Education, Dr. Briggs
served on the faculty of George Washington University for
25 years, fourteen of which were as the Dean of the School of
Pharmacy.

A veteran of six years service, Commander Briggs served
in the United States Navy during World War II from 1942 to
1945 and again, on special assignment from 1948 to 1951.

“3 e
46

a - a24} = ae 4 + = i: = _ 1]
Ae abate Eee i

+.

Dr. W. Paul Briggs (right) receives the Honorary President’s Plaque from
Leon Weiner (left), President of the Alumni Association.

Photos By Paramount Photo Service

24 THE MARYLAND PHARMACIST

A member of the Committee on Pharmaceutical Survey,

|

Dr. Briggs participated in a three year study of the

pharmaceutical profession and its educational systems at the
request of the American Council of Education.

A former Secretary of the National Drug Trade Con-

|

ference, Dr. Briggs also served on the Board of Trustees of ©

the United States Pharmacopeia. In 1957 he was awarded
Pharmacy’s highest honor, the Remington Medal.

A member of Rho Chi and an honorary member of Alpha
Zeta Omega and Kappa Psi, Dr. Briggs completed his
undergraduate work at George Washington University and
received his Master’s Degree from the University of
Maryland. In addition, Dr. Briggs has been awarded
Honorary Degrees from the Philadelphia College of Phar-
macy and Science, Temple University, Ohio Northern
University, and» Northeastern University.

Dr. Briggs also received the Alumni Achievement Award
from George Washington University for distinguished
services to the university, the government, and his profes-
sion.

Following the award presentation Mr. Irving Rubin,
editor of PHARMACY TIMES gave an informative talk on
“Ten Predictions for Pharmacy in 1980”.

At the conclusion of his lecture Mr. Rubin was presented
with a plaque in recognition of his contributions to the
advancement of pharmacy by the Chairman Henry G.
Seidman, President of the Alumni Association who is also
the current President of MPhA.

A 1936 graduate of the Brooklyn College of Pharmacy,
Mr. Rubin has over 25 years experience in editing phar-
maceutical publications. A nationally recognized writer and
lecturer on pharmaceutical subjects, Mr. Rubin was award-
ed the first Annual Achievement Award from the Brooklyn
College of Pharmacy. In 1964 he received numerous honors
and awards for editorial achievement and public service
from the Alpha Zeta Omega Pharmaceutical Fraternity and
the American Cancer Society.

Among Mr. Rubin’s editorial projects have been the
Pharmacists’ Oath, which is administered to all pharmacists
nationwide upon graduation, a United States Postage
Stamp issued in 1972 by the Post Office Department in
honor of the pharmacists’ contributions to American
society, and a book entitled “The Pharmacy Graduate’s
Career Guide”.

APRIL 1976

?
:

OOS EEO RR ERE ete

Irving Rubin (right), Editor of PHARMACY TIMES, is presented with a
plaque in recognition of his contributions to the advancement of pharmacy
by Henry G. Seidman, Vice President of the Alumni Association and

Dinner Meeting Chairman.
Photos By Paramount Photo Service

The Invocation was delivered by Sanford L. Rosenbloom
and George Voxakis, Executive Secretary of the Alumni
Association, delivered the Benediction at the conclusion of
the evening’s program.

Serving on the Dinner Meeting Committee of the Alumni
Association were Henry G. Seidman (Committee Chair-
man), Milton A. Friedman, Dorthy Levi, Bernard Macek,
Larry Rosenbloom, Charles A. Sandler, Ronald Sanford,
Charles Tregoe, George Voxakis, H. Nelson Warfield,
William Weiner, and Leon Weiner.

Sustaining Members
Maryland Pharmaceutical
Association

BORDEN-HENDLER COMPANY
CALVERT DRUG COMPANY
F, A. DAVIS & SONS
H. B. GILPIN COMPANY
LOEWY DRUG COMPANY
MARYLAND NEWS COMPANY
MILLER DRUG SUNDRY COMPANY

APRIL 1976

INSTITUTIONAL PHARMACY (continued from page 22)

; 1232-42
intraocular pressure. As with systemic corti-
costeroids, there is also reason to believe that topical

corticosteroids can be cataractogenic.! :
Use of Ophthalmic Solutions in a Geriatric Hospital

In an attempt to gather some information on the
actual use of eye drops in the geriatric population, a sur-
vey was conducted of the current orders for ophthalmic
drops for the patients in a geriatric hospital in the Balti-
more, Maryland, vicinity. The hospital has approximately
265 beds.

The survey showed 67 patients (27 percent) using
ophthalmic solutions. The average age of 49 of these pa-
tients (age not available for others) was 83 years. There
were 83 ophthalmic orders in effect for these 67 patients,
representing 24 different products. Many of these were
combination products. Thus, frequently, a patient re-
ceived more than one drug (for example, anti-infective
plus steroid).

Over one fourth (27 percent) of these patients were
using some kind of eye drop. The miotics are most fre-
quently used, i.e., 36 percent of the patients using
ophthalmic drops received miotics. This represents al-
most 10 percent of the hospital population, comparing
favorably with the highest estimates in the literature of
the prevalence of glaucoma in the general population
over age 40. The prevalence of glaucoma in the hospital
population, however, would be expected to be higher
than that in the general population, because the hospi-
tal population would be considerably older than the
general population and the hospitalized patients would
receive regular eye examinations, thus decreasing the
chance of glaucoma going undetected.

The antihistamine-decongestants were also frequently
used, most often for tired, red eyes. Most of these solu-
tions contain phenylephrine or other vasoconstrictors. It
is recommended that these drugs be used with caution in
patients with narrow-angle glaucoma. In the geriatric
population it is quite likely that there will be persons
disposed to narrow-angle glaucoma, but not diagnosed as
such. It would make sense, especially in the older popula-
tions, to use ocular lubricants rather than vasoconstrictors
whenever possible to avoid the possibility of precipitating
an attack of narrow-angle glaucoma.

A frequently prescribed individual product was a de-
congestant containing boric acid. Boric acid can cause
rather serious toxic effects when absorbed systemically
and has, for the most part, fallen into disuse. However,
it is still used in ophthalmic solutions as a preservative
and/or buffering agent, and one may well question its
possible toxic effect due to long-term chronic use in

INSTITUTIONAL PHARMACY (continued on page 30)

THE MARYLAND PHARMACIST

25

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Paramount means
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Baltimore, Maryland 21218

Phone: Baltimore — 366-1155; Washington (local call) 484-4050

PAUL REZNEK CITED BY
MARYLAND STATE SENATE

Paul Reznek, Executive Secretary of the Prince
George/ Montgomery County Pharmaceutical Association
and long active in the affairs of professional pharmaceutical
associations, was honored by the Maryland State Senate
with a Resolution of congratulation for his contributions to
pharmacy. Resolution introduced by State Senators Victor
L. Crawford and Arthur Dorman. The Resolution reads as
follows:

SENATE RESOLUTION
INOg 127

A Senate Resolution concerning
Paul Reznek

FOR the purpose of congratulating Paul Reznek on his
many accomplishments during a long career in pharmacy.

Paul Reznek has completed fifty years of distinguished
service to the Pharmaceutical profession.

He is a member of the Maryland Pharmaceutical Associa-
tion, the Prince George’s - Montgomery County Phar-
maceutical Association, the National Association of Retail
Druggists, the American Pharmaceutical Association, the
Alpha Zeta Omega Pharmaceutical Fraternity, the District
of Columbia Pharmaceutical Association, the Metropolitan
Pharmaceutical Secretaries’ Association, and _ the
Metropolitan Guild of Pharmacists.

He is presently Executive Secretary of the Prince George’s
- Montgomery County Pharmaceutical Association, Editor
of the “Bi-County Pharmacist”, Editor of the Golden
Anniversary Issue of “The Azoan”, and the National
Legislative Representative for the Alpha Zeta Omega
Pharmaceutical Fraternity.

He has received the Honorable Mention Lederle Award for
Interprofessional Services for 1971, the Past President’s
Award of the Prince George’s - Montgomery County
Pharmaceutical Association for 1966, the Alpha Zeta
Omega Pharmaceutical Fraternity Double Star Award for
Meritorious Service to Pharmacy, the Alpha Zeta Omega
Meritorious Award for 1974, and the Bowl of Hygeia for
Maryland for 1974.

He has been a staff member of the Maryland Phar-
maceutical Association, Assistant Editor of the “Maryland
Pharmacist”, a member of the Pharmaceutical Association
Committee on Public Relations, a past Associate Editor of
the “National Capital Pharmacist,” and President of the
District of Columbia Pharmaceutical Association.

He received his formal pharmaceutical training at Temple
University, graduating in 1929.
APRIL 1976

He has recently been nominated to be Honorary President
of the Maryland Pharmaceutical Association; now,
therefore be it

RESOLVED BY THE SENATE OF MARYLAND,
That this Body notes the impressive accomplishments of
Paul Reznek in the demanding profession of Pharmacy; and
be it further

RESOLVED, That this Body extends its congratulations
to Paul Reznek in recognition of his completion of fifty years
as an outstanding Pharmacist; and be it further

RESOLVED, That a copy of this Resolution be sent to
Paul Reznek, 11700 Old Columbia Pike, Silver Spring,
Maryland 20904.

ELSBERG HONORED BY ADL

MPhA member Milton L. Elsberg, President of Drug Fair
Stores, Inc., was the guest of honor recently at a dinner in the
New York Hilton Hotel sponsored by the Drug, Toiletry and
Cosmetic Industries Division of the Anti-Defamation
League of B’nai Brrith.

Mr. Elsberg was presented with the Torch of Liberty
Award by Louis L. Avner of the Thrift Drug Company and
Frank H. Barker of Johnson and Johnson, co-sponsors of
the event.

N.A.R.D. TO HOLD EXAMINATIONS
FOR CERTIFICATION

The National Association of Retail Druggists has an-
nounced that the first written and practical examinations for
their Voluntary Supports and Appliances Program will be
administered prior to and in conjunction with their Annual
Meeting to be held in San Francisco in September of 1976.

A pharmacy applying for certification in NARD’s Volun-
tary Supports and Appliances Program must submit
evidence of being able to offer the services of qualified fitting
personnel, maintain an adequate inventory of surgical
appliances, provide a private well-equipped fitting room and
other services. A pharmacist applying for certification must
present, during the “grandfather clause” period, adequate
proof of training and fitting experience in order to qualify.
He must be associated with a pharmacy or pharmacist-
owned outlet. The same criteria applies to associate fitters.

THE MARYLAND PHARMACIST 27

Readers’ Input...

The following is a copy of a letter sent to Dr. Neil
Solomon, Secretary of Health and Mental Hygiene, in
reference to legislation proposed by the Maryland Board of
Pharmacy.

Dear Dr. Solomon,

I am a pharmacy owner who practices pharmacy as an
individual, by reducing evening hours, shortening Saturday
hours, and closing Sunday. With the spiraling costs of wages
the financial success of an independent pharmacy may
require individual ownership, solely operated, in a small
professional area, specializing in prescription service, witha
much-shortened work schedule. The aforementioned is
anthithesis of the large corporate chain requiring long
business hours, a large physical area, and in practical terms a
general merchandise store with a pharmacy department.
Presently the general stores with a pharmacy department
have attempted to reduce their expenses by closing the
pharmacy department at specific hours. This legitimate
business action has caused a violent reaction from organized
pharmacy claiming public danger from employee-
pharmacists claiming a loss of job security and wages. On
this foundation of utter chaos comes the regulations of the
Maryland State Board of Pharmacy which describes the
manner by which the pharmacy department may be closed
when the pharmacist is not on duty. If the practice of
pharmacy as a profession in the future rests in the grocery
store or general merchandise store, then the regulations as
proposed by the State Board of Pharmacy are in the best
interests of pharmacy.

If the practice of pharmacy is to be what it was and can be
again, that is, an individual pharmacist owning and prac-
ticing his profession in a small professional surrounding then
the proposed regulation is totally destructive to the
professional progress of pharmacy. It is imperative that a
distinction be made between pharmacies that are located in
general merchandise stores and pharmacies that are by
physical design and percentage of gross income solely
pharmacies. The distinction is necessary so that we may
foster the propagation of, in terms of the naturalists, an
endangered species.

How many private practitioners, who are licensed in other
professions can’t get a haircut, go out fora hot lunch, or have
a business appointment without closing their offices? The

28 THE MARYLAND PHARMACIST

answer is: None! The administrative and non-professional
duties of the pharmacist can and should be taken care of by
responsible delegated aides. A pharmacist should not be
required to be on duty for non-professional to answer
phones and accomplish the duties that secretaries are quite
capable of doing. Delegation of duties to non-professionals
is necessary if the practice of professional pharmacy is to
survive and flourish. The health and welfare of the citizens of
Maryland depends upon a licensed pharmacist using his
expertise and knowledge in the act of dispensing a prescribed
medication. As long as the dispensing act is not consumated
to the public then the prior administrative acts of the
pharmacist’s assistant should be the responsibility of the
pharmacist not the State. The judgement and legal respon-
sibility for dispensing the prescription is the pharmacist’s.
The simple fact is that there are many procedures prior to
dispensing a prescription which do not require a pharmacist
to accomplish, therefore it is arbitrary and capricious to have
the state demand that those actions have a pharmacist
present when they are performed, i.e., answering the phone,
renewal requests, retrieving prescriptions from files, receiv-
ing prescriptions from patients, counting and pouring
medications, typing or labeling containers. The only concern
of the state should be the following: Has a licensed
pharmacist determined that the medication dispensed is
properly prescribed, filled, labeled and therefore safe for the
intended treatment of the patient. Any other determination
by the state violates the individual freedoms and rights of the
pharmacist and will as we have seen by the myriad of rules
and regulations suffocate the individual practice of
professional pharmacy.

Pharmacists have traditionlly been fearful that the free
enterprise system would destroy us if we didn’t do something
drastic to protect ourselves from it. The fears that stimulated
the State Board of Pharmacy to write the rules of “How to
close the pharmacy and wish you hadn’t” are based upon the
fact that a pharmacy could be open at various times during
the day and have technicians present during the times when
the pharmacist was not on duty. No one has ever asked the
public if they would support a “I’m sorry you just missed the
pharmacist pharmacy”. Let the people not the state decide in
the market place the ultimate success or failure of this
pharmacy practice. The adoption of the proposed state
regulation is totally destructive and will only be another set
of unnecessary, repressive, and ridiculous Rube Goldberg
rules that have become the trademark of our profession.

Sincerely,

M. Neal Jacobs,
Registered Pharmacist

Laurel, Maryland

APRIL 1976

een oe re

HelpYourshelt..

\
@)

A lot of fine peau A
compete for the custom-
j PYN/s

ers dollars, at your phar-

macy. So, when it comes time

to stock your shelves, THE &
MARYLAND NEWS DISTRIBUTING @&
COMPANY is well aware of your needs.

Our product is periodicals — magazines
and paperback books — and we continually
supply your racks with a variety of current
reading material appealing to every taste and
keeping your customer reader interest at its
highest.

We understand that turnover is important.
With periodicals you have a sufficient new
product each month to stimulate traffic not
only for our product, but for a// the products
in your store.

An investment of $100 in periodicals,
normally will result in $127 of sales within 30

a days. Not bad! Then
WV think of all the other
/ products you will sell.
~ Further, since all unsold
copies of our product are return-
=~" able for credit, there is absolutely

no risk.

é But perhaps the most important fact
is that periodicals have an unselfish way of
helping to sell every other product in your
store. Take a look at the pages of our maga-
zines and see how they showcase just about
every other product that you sell over and
over again. It is like having a built-in
salesman.

To learn how you can really “help your-
shelf,” why not give us a Call;
The Maryland News Distributing Co.
(301) 233-4545
Ask about periodicals, the unselfish product.

eloiltuaries

MPhA Member

Maxwell A. Krucoff

Maxwell A Krucoff, 67, Member of the MPhA and
BMPA, died on April 19, 1976 at Union Memorial Hospital
after a short illness. A native of Baltimore, Mr. Krucoff
graduated from City College in 1925 and from the University
of Maryland School of Pharmacy in 1928. Mr. Krucoff had
owned and operated Maxwell’s Pharmacy at Laurens Street
and Fremont Avenue since 1944.

A former member of the board of the Bonnie View
Country Club, he had belonged to the Great Books Society,
a discussion group, and joined the Maryland Academy of
Science because of his interest in astronomy.

He is survived by his wife, the former Gladys Bichell; two
sons. Karl H. Krucoff, of Boulder, Colorado, and Walter A.
Krucoff, of Crofton, Maryland; three sisters, Mrs. Anna
Rosenthal and Mrs. Mildred Goldberg, both of Baltimore,
and Tille Krucoff, of Setauket, N.Y.

Other Obituaries
Raymond C. Robinson

Dr. Raymond C. Robinson, a 1936 graduate of the
University of Maryland School of Pharmacy and a 1940
graduate of the University of Maryland School of Medicine,
died on March 18, 1976.

Aaron S. Abramsom

Aaron S. Abramson, 52, pharmacist and owner of Kay
Cee Drugs in District Heights, Maryland, died on April 19,
1976, at Prince George’s General Hospital.

METCALF APPOINTED
GILPIN V.P. SALES

Mr. James E. Allen, Jr., Executive Vice President of the
Henry B. Gilpin Company, recently announced the appoint-
ment of Harry N. Metcalf as Vice President-Sales of the
Gilpin Wholesale Drug Company.

Mr. Metcalf held various sales and division management
positions with Foremost McKesson in all areas of the United
States and joined Gilpin from his most recent position as
Regional Vice President, Service Sales, Eastern Region.

With Gilpin, Mr. Metcalf will be responsible for wholesale
drug sales as well as sales of the DATAREX, Micro-Info,
Tip-Top and CARE programs. The Henry B. Gilpin
Company operates six wholesale drug distribution centers,
serving thirteen states in the East, South, and Midwest.

30 THE MARYLAND PHARMACIST

Ealendar

June 18-20 (Friday, Saturday and Sunday) —
Maryland Society of Hospital Pharmacists An-
nual Seminar, Sheraton Fontainebleau Hotel,
Ocean City, Maryland.

June 20-23 (Sunday, Monday, Tuesday and
Wednesday) — Maryland Pharmaceutical
Association’s 94th Annual Convention, Sheraton
Fontainebleau Hotel, Ocean City, Maryland.

June 21 (Monday) — TAMPA and LAMPA
Annual Meetings, Sheraton Fontainebleau
Hotel, Ocean City, Maryland.

INSTITUTIONAL PHARMACY (continued from page 25)

ophthalmic drops. In comparing the toxic dose of boric
acid in adults (8 to 30 Gm.) and the amount commonly
used in ophthalmic drops (0.002 to 1.2 percent) the time
required to build up a toxic dose can be calculated. Using
a preparation containing 0.7 percent boric acid, for
example, at a dose of two drops four times a day (assum-
ing 10 drops per ml., and assuming 100 percent absorp-
tion), the dose should be easily tolerated in a person with
adequate renal function. In the person with no renal
function, it would take over four years to reach a total
body store of 8 Gm. It would appear that boric acid con-
taining eye drops can generally be considered safe when
used chronically for long periods of time.*?

Considering that the literature dealing with eye pro-
blems in the elderly did not indicate a higher incidence
of inflammation and infection in older individuals, there
were large numbers of orders for anti-infectives and
steroid-containing products. One might wonder if this
high usage (17 percent of all drops in 24 percent of the
patients) is justified, especially in light of the previously
mentioned reports of increased intraocular pressure and
increased rate of cataract formation associated with the
use of steroid products.

Summary

The aging process leaves the older patient with unique
eye problems for which ophthalmic drops are frequently
indicated. The use of these drops, however, is not com-
pletely without possible adverse effects. It is only by
being aware of the physiologic and anatomic changes in
the aging eye and the possible harmful effects of the
various drugs used for treatment of ocular conditions,
that the visual well-being, so important to the older pa-
tient, can be guaranteed.)

APRIL 1976

CONVENTION BULLETIA

ee

24TH ANNUAL CONVENTION
MARYLAND PHARMACEUTICAL ASSOCIATION

in conjunction with

LAMPA and TAMPA - The Ladies and Travelers Auxiliaries
SHERATON FONTAINEBLEAU, OCEAN CITY, MARYLAND

Sunday through Wednesday - June 20-23rd

The Sheraton Fontainebleau is the perfect beach side hotel -- all rooms have a
spectacular ocean view. It also offers an indoor-outdoor swimming pool, tennis
courts, sauna and exercise room, restaurant and cocktail lounge. Golf nearby at

special MPhA convention rate, deep sea fishing, Frontier Town and Amusement parks.
Free parking.

ROOMS LIMITED

Don't be disappointed. Mail your reservation and registration early!
Reservations can only guaranteed if received by Friday JUNE Gry

eee

&# & &@ & &@ @ TF &

REGISTRATION REQUIRED

All attendees for the educational, social, entertainment, recreational
and food functions must be registered.

REGISTRATION FEES

All programs, listed social and food functions, bioavailability work-
shop and materials and prizes: $45.00, Ladies: $40.00. Other
attendees not attending C.E. Programs: $35.00. Pharmacy Students: $20.

- =
wewrnreewwrnnwewewewrw ww enw wrewwr een we mew eww mr ww ewe ewww eee ewww nowrese ee ewwwren er enweereerwwr eee ee

CONVENTION REGISTRATION FORM
MARYLAND PHARMACEUTICAL ASSOCIATION - LAMPA - TAMPA

Name Name
Address Address
Name Name
Address Addressee

(Use reverse stde for addittonal names.) PLEASE INCLUDE FIRST NAME OF LADIES.

Enclosed is check $ for registration and functions as follows, tneluding
$30.00 room depostt.

PACKAGE AND INDIVIDUAL CHARGES

Pharmacist Registrations @ $45.00 Non-pharmacist Registration without
Ladies @ $40.00 GcE. ¢$35..00

Sunday cocktail party @ $10.00 Tuesday Reception, Banquet and Dance
Monday LAMPA Brunch @ $7.00 @ $20.00

Monday Crabfeast and Dance @ $10.00 Wednesday C.E. @ $10.00

Children Crabfeast @ $3.50; Children Banquet @ $8.50

Make check payable to MPhA, 650 West Lombard Street, Baltimore, Maryland 21201
Area Code 301-727-0746. INCLUDE SEPARATE CHECK FOR DUES, IF NOT PAID.

SUNDAY, June 20

9:30 P.M.

1a 9:00 A.M. to

7 1:00 0PM:

10:00 A.M.

2650.2 Me

1 O0REsM:
G6 O0RDe M2

TUESDAY, June 22
9:00 A.M.

6:00 P.M.
Lc OURKeM:

WEDNESDAY, June 23
9:00 A.M. to

Follows MSHP Annual Seminar June 18-20.

{

CONVENTION TIME

MPHA ANNUAL CONVENTION AND FAMILY MINI-VACATION

Co-sponsored by TAMPA and LAMPA |

HERATON FONTAINEBLEAU, OCEAN CITY, MARYLAND

JUNE 20-23, 1976

Same Place

PROGRAM HIGHLIGHTS

Registration opens
Tennis Tournament begins - Golf available
Children's supervised programs daily
Welcome cocktatl party and receptton

Opening General Session

House of Delegates - First Session
Officers' Reports

Report of Board of Pharmacy

LAMPA - Brunch, Meeting and Fashton Show
TAMPA - Annual Meeting
Bicentennial Feature for All
"The Apothecary and the Practice of Medicine tn
Colontal Times" - Lecture and slide presentation by
Morris L. Cooper, Curator MPhA Cole Pharmacy Museum

Golf, Tennis and Beach

Crabfeast and other goodtes.
TAMPA Program: Square Dance

Berlin Ftre Hall

House of Delegates - Second Session

Elections of Nominees to State Board of Pharmacy
Nomination of Officers and Trustees for Mail Ballot
Final Session

Cocktatl Party

Annual Banquet and Dance

Continuing Education Sessions - Certificate of
Attendance and C. E. Credits - Co-sponsored by
APhA Academy of Pharmacy Practice. "Understanding
and Using Bioavailability Information: An Actton
Seminar" Workshops conducted by Richard P. Penna
and Ronald Williams.

“Professional Standards of Practice:
Mandatory or Voluntary?”

Contamination Incidence In An
IV Admixture Program

~

RAY HECKMAN

U/

DEAN SULLIVAN

4

GORDON KNIGHT

BILL HYSSONG
JOHN O'MALLEY

.

MIKE GERSHEN

é ©
4

BOB GITTINGS Die
TOM DONOVAN

BOB MUMMEY TIM BRODERICK

WE'RE PUTTING
OUR BEST FACES FORWARD

The faces of SAGF Representatives who stand ready

to help you in any way with anything to do with SKGF.

If you have 8 question or a problem, just ask. “
Ya

Smith Kline & French Laboratories UV)

Division of SmithKline Corporetion

The one the patient takes
is never tested.

Surprising, perhaps, but it makes sense
when you think about it.

Obviously, the actual dose of any pre-
scription drug the patient takes cannot be
tested because it would have to be broken
down for analysis—after which it could
never be used by a patient.

This means that you depend on the
manufacturer for assurance that the dose
the patient takes is identical to the ones
which have been tested.

At each step in the manufacture of a
Lilly drug, test after test confirms the in-
eredients, formulation, purity, and
accuracy —all the critical factors that as-
sure that every Lilly medicine is just what
the doctor ordered.

Thats particularly important, as you
know. The same drug made by different
companies can be chemically identical
yet may act differently in the human body
because of the many variables in the way
the drugs are manufactured.

And, of course, government standards
alone do not assure the efficacy and con-
sistency—the quality of each drug you
dispense.

As we at Eli Lilly and Company see it,
the ultimate responsibility for quality is
ours.

For four generations weve been mak-
ing medicines as if people’ lives depended
on them.

600090

Lilly

ELI LILLY AND COMPANY, INDIANAPOLIS, INDIANA 46206

WHEN YOU
SPEAK
WE LISTEN

At Sandoz Pharmaceuticals, many of our changing procedures and
policies come from ideas and suggestions given to us by pharmacists
from all over the country.

For example, simplified inventory control for our products with a shelf
life of over two years was instituted when pharmacists found that :
monthly dating required unnecessary monthly checking. As a result,
these products are now dated either January or July and shelf-life
checks need to be taken only twice a year.

Greater label clarity, showing strength and form of products at a
glance, was another suggestion. And, in the unit-dose line, our
SandoPak® packages are available because hospital pharmacists asked
for this innovation. Subsequently, they asked us to Incorporate a
child-resistant element into those packages, and we are now phasing
in that feature.

Our return goods policy has also been Shaped according to
pharmacists’ suggestions... making returns as easy and as economical
as possible.
We constantly review our relationship to pharmacists and keep
looking to you for your ideas on what will help you to better

- serve our common interest, the patient.
SANDOZ PHARMACEUTICALS, EAST HANOVER, NEW JERSEY 07936. “sun's. 4e0~

THE MARYLAND PHARMACIST

650 WEST LOMBARD STREET
BALTIMORE MARYLAND 21201
TELEPHONE 301/727-0746

VOL. 52 MAY 1976 NO. 5
6 Editorial
4,5, 22 Institutional Pharmacy
18-19, 21. U.S.P. Drug Problem Products Report
8 MPhA Calendar
11. MPhA News
29 Obituaries
— nee
16-17, 20-21 Burroughs Wellcome 21 Norcliff Pharmaceuticals
11. ~+F.A. Davis 25 Paramount Photo Service
8 Calvert Drug Company 30-31 Pharmaceutical Manufacturer's
29 ~=— District Photo Service Association
9-10 Geigy Pharmaceuticals 26-27 Roche Laboratories
12-13 The Henry B. Gilpin Company 4 Sandoz
SE ellyaenGOnmnGs 23. A.H. Robins Company
32 Loewy Drug Company 2 Smith, Kline and French
28 The Maryland News 24 CIBA

Distributing Company
7 Mayer & Steinberg Inc.

Change of address may be made by sending old address (as it appears on
your journal) and new address with zip code number. Allow four weeks for
changeover. APhA members—please include APhA number.

The Maryland Pharmacist is published monthly by the Maryland Pharma-
ceutical Association, 650 W. Lombard Street, Baltimore, Md. 21201. Subscription
price $5.00 a year. Entered as second class matter December 10, 1925, at the
Post Office at Baltimore, Maryland, under the Act of March 8, 1879.

SEX,

NATHAN I. GRUZ, Editor
PETER P. LAMY, PhD.,
Institutional Pharmacy Editor
MICHAEL J. SHIELDS, JR.,
Assistant Editor

ROSS P. CAMPBELL,

News Correspondent
HERMAN BLOOM,
Photographer

OFFICERS & BOARD OF TRUSTEES
1975-1976

Honorary President

FRANK BLOCK

President

HENRY G. SEIDMAN - Baltimore
President Elect

MELVIN N. RUBIN - Arbutus

Vice President

RICHARD D. PARKER - Kensington
Treasurer

MORRIS LINDENBAUM

5 Main St., Reisterstown, Md. 21136
Executive Director

NATHAN I. GRUZ

650 W. Lombard St., Baltimore, Md. 21201

PAUL FREIMAN, Chairman

Baltimore

S. BEN FRIEDMAN (1976)
Potomac

ROBERT J. MARTIN (1977)
LaVale

ROBERT E. SNYDER (1978)
Baltimore

JAMES W. TRUITT, JR. (1976)
Federalsburg

LEONARD J. DIMINO (1978)
Wheaton

STANLEY J. YAFFE (1977)
Odenton

EX-OFFICIO MEMBERS
WILLIAM J. KINNARD, JR. - Baltimore

HOUSE OF DELEGATES

Speaker

IRVIN KAMENETZ - Owings Mills
Vice Speaker

SAMUEL LICHTER - Randallstown
Secretary

NATHAN I. GRUZ - Baltimore

MARYLAND BOARD OF PHARMACY
President

MORRIS R. YAFFE - Potomac
CHARLES H. TREGOE - Parkton

I. EARL KERPELMAN - Salisbury
RALPH T. QUARLES, SR. - Baltimore
Secretary

ROBERT E. SNYDER - Baltimore

editorial

PROFESSIONAL STANDARDS OF PRACTICE —
MANDATORY OR VOLUNTARY?

We have arrived at the point where everyone recognizes
that pharmacy is one of the most regulated professions. This
has occurred for many reasons.

Historically, the necessity for regulation grew out of the
need to assure that the drug supply of the nation was “pure
and unadulterated.” Thus, official compendia such as the
USP (The Pharmacopeia) and the N.F. (National For-
mulary) were established. At the same time local, state and
federal “pure food and drug laws” were enacted.

Also, through the years pharmacists have sought to
upgrade the profession, advance their professional interests
and seek remedies for most of their perceived problems
through laws and regulations. At the same time, especially in
recent years, legislators and now consumer activists have
initiated legislative proposals in an attempt to regulate the
practice of pharmacy not only in general terms, but often in
minute detail.

There are two controversial issues that have emerged in
the past decade which a number of state pharmaceutical
associations have tried to resolve by legislation or regula-
tion: continuing education (C.E.) and patient medication
profiles.

Controversy has prevented agreement ona specific law for
a CE requirement for relicensure in Maryland. In the
meantime, the MPhA Pharmacy Practice Committee has
recommended that an MPhA committee set up a procedure
for evaluating CE programs and assigning credits with the
view of MPhA certification on a voluntary basis of those
who meet the criteria.

In the area of patient medication profiles, a bill initiated
by a state legislator to require profiles failed of enactment.
Patient profiles are already a standard of good pharamcy
practice adopted by the MPhA Board of Trustees. The
MPhA Pharmacy Practice Committee is now recommen-
ding the establishment of a procedure for certification on a
voluntary basis of these pharmacies which maintain and
properly utilize profiles according to specified criteria.

These recommendations for voluntary compliance with
requirements, standards and criteria developed by one’s
peers will be presented to the MPhA House of Delegates for
debate.

6 THE MARYLAND PHARMACIST

Here is an opportunity for the pharmacists of Maryland to
show an awareness of both society’s and the profession’s
requirements in order to effectively discharge their legal and
professional responsibilities in serving the health care needs
of the public.

The ability and commitment to work through professional
societies such as MPhA to develop high voluntary standards
of pharmacy practice, to adopt them, and to implement
them, are hallmarks of a true profession. Such concrete
action would be evidence that would clearly demonstrate
that pharmacists’ first priority is to serve the pharmaceutical
service needs of the public in the most effective manner that
is possible.

The results are bound to bea giant step toward perception
by the public, other health professions, the courts,
governmental agencies and legislators of pharmacists as
primarily health care professionals. Even the best public
relations programs can not for long supplant the “realities”
or facts as perceived by the various publics who confront us.
Legislative efforts may in many cases only result in
temporary respites, in the end often counterproductive. The
old adage “actions speak louder than words” is truly
appropriate in this context.

The course of voluntary response to the solution of
pharmacy’s responsibilities is the path most likely to prevent
further governmental regulatory intervention.

— Nathan I. Gruz |

MAY 1976

MPnA
DIVIDEND CHECKS!

As a participating member in the MPhA
Workmen’s Compensation Program,
you can receive a return of the profits

derived from your annual
premium. Every year! Up to 35%!
Interested? Ask Us!
This plan underwritten by A. D. I.

Your American Druggists' Insurance Co. Representative

MAYER“ STEINBERG":

General Insurance Agents and Brokers
NEW ADDRESS
600 REISTERSTOWN RD. BALTO., MD.

(301) 484-7000

calendar
|

September 9 (Thursday) Maryland Society of Hospital
Pharmacists Meeting, Johns Hopkins Hospital,
Baltimore, Maryland.

September 19-23 (Sunday, Monday, Tuesday, Wednesday,

Thursday) NARD Convention, San Francisco.

NPhA ANNUAL MEETING
LOS ANGELES, AUGUST 1-5

The National Pharmaceutical Association will host thei
Annual Convention this year from August I-5 at th
Marriott Hotel in Los Angeles, California.

The National Pharmaceutical Association is a
predominantly Black organization dedicated to the solution
sS of problems and peculiarities encountered in the practice o
pharmacy within the inner cities nationwide. According toa
release by the association, “There will come a time,

Sustaining Members

Maryland Pharmaceutical hopefully, when the need for our Black National .
Association maceutical Association will no longer exist — a time when
BORDEN-HENDLER COMPANY the problems of a Black Pharmacist practicing ghetto
CALVERT DRUG COMPANY pharmacy dominated by Medi-caid prescriptions and

F. A. DAVIS & SONS threatened by our own Brothers intent on ripping off the

H. B. GILPIN COMPANY establishment exemplified by us will no longer exist. ...

LOEWY DRUG COMPANY Until that time arrives, however, our National Phat

MARYLAND NEWS COMPANY

MILLER DRUG SUNDRY COMPANY maceutical Association dedicated to the problems peculiar

to our own group alone, is a necessary and viable organiza-
tion.”

|
9 oe 0%e 0%e 080 ote 0%e 00s 000 ote ote ore ore ote ote ote ornate ate ste ete ete se” 0 San
Ma? gt Mo M9 O,% O49 9,9 9,9 0,9 9 99 000,009 09 09 9.9 0.0 090900000000 006, IX IX So oe ete

“IMPROVE!!!

YOUR PROFIT — YOUR SALES — YOUR TURNOVER:
with |

CALVERT’S

PROVEN PROGRAMS 3

ASTRO = CO-OP AD PROGRAM ;
CAL-SAV = POINT OF PURCHASE PROGRAM

©. o%
o° 0,0 %,0

A.P.P. = ACCUMULATIVE PURCHASES PROGRAM

D.P.P. = DIRECT PURCHASE PROGRAM ,

W.S.P. = WEEKLY SPECIALS PROGRAM $

and

C.P.P. = CONTROLLED PERCENTAGE PROGRAM :

PHONE: (301) 467-2780

})

THE CALVERT DRUG COMPANY =

901 CURTAIN AVENUE i

BALTIMORE, MARYLAND 21218 :

%

0 fe oe fe oe DP SCC X . fe fe ofe ole ole 0% 52 a 5 30 00 ofe ofe ofe ole 0% ole ofs ofe fe ole fe oe eke ote ote pete
8 THE MARYLAND PHARMACIST MAY tot

Tofranil-PM° Geigy

imipramine

In depression

Daily Dosage Chart

Tofranil-PM”°

imipramine pamoate

One capsule
lasts from bedtime
to bedtime.

Initial Dose For Maintenance Therapy

Usual Optimum
Response Dose

Starting A Full Range to Choose From*
Dose

MGM asi...

ro 150 OU 125 100 TAS
mg. mg. mg. mg. mg. mg.

“Each capsule contains imipramine pamoate
equivalent to 150, 125, 100 or 75 mg. imipramine
hydrochloride.

Tofranil-PM®
brand of imipramine pamoate

Indications: For the relief of symptoms of depression.
Endogenous depression is more likely to be alleviated
than other depressive states.

Contraindications: The concomitant use of monoamine

oxidase inhibiting compounds is contraindicated. Hyper-

pyretic crises or severe convulsive seizures may occur in
patients receiving such combinations. The potentiation of
adverse effects can be serious, or even fatal. When it is
desired to substitute Tofranil-PM, brand of imipramine
pamoate, in patients receiving a monoamine oxidase in-
hibitor, as long an interval should elapse as the Clinical
situation will allow, with a minimum of 14 days. Initial
dosage should be low and increases should be gradual
and cautiously prescribed. The drug is contraindicated
during the acute recovery period after a myocardial! infarc-
tion. Patients with a known hypersensitivity to this com-
pound should not be given the drug. The possibility of
cross-sensitivity to other dibenzazepine compounds
should be kept in mind.

Warnings: Usage in Pregnancy: Safe use of imipramine

during pregnancy and lactation has not been established;

therefore, in administering the drug to pregnant patients,
nursing mothers, or women of childbearing potential, the
potential benefits must be weighed against the possible
hazards. Animal reproduction studies have yielded incon-
clusive results. There have been clinical reports of con-
genital malformation associated with the use of this drug,
but a causal relationship has not been confirmed.

Extreme caution should be used when this drug is given

to:

—patients with cardiovascular disease because of the
possibility of conduction defects, arrhythmias, myocar-
dial infarction, strokes and tachycardia;

—patients with increased intraocular pressure, history of
urinary retention, or history of narrow-angle glaucoma
because of the drug's anticholinergic properties;

—hyperthyroid patients or those on thyroid medication
because of the possibility of cardiovascular toxicity;

—patients with a history of seizure disorder because this
drug has been shown to lower the seizure threshold;

—patients receiving guanethidine or similar agents since
imipramine may block the pharmacologic effects of
these drugs.

Since imipramine may impair the mental and/or physical

abilities required for the performance of potentially

hazardous tasks such as operating an automobile or
machinery, the patient should be cautioned accordingly.

Usage in Children: Tofranil-PM, brand of imipramine

Pamoate, should not be used in children of any age be-

cause of the increased potential for acute overdosage

due to the high unit potency (75 mg., 100 mg., 125 mg.
and 150 mg.). Each capsule contains imipramine

pamoate equivalent to 75 mg., 100 mg., 125 mg. or 150

mg. imipramine hydrochloride

Precautions: |t should be kept in mind that the possibility

of suicide in seriously depressed patients is inherent in
the illness and may persist until significant remission oc-
curs. Such patients should be carefully supervised during
the early phase of treatment with Tofranil-PM, brand of
imipramine pamoate, and may require hospitalization.
Prescriptions should be written for the smallest amount
feasible.

Hypomanic or manic episodes may occur, particularly in
patients with cyclic disorders. Such reactions may neces-
sitate discontinuation of the drug. If needed, Tofranil-PM,
brand of imipramine pamoate, may be resumed in lower
dosage when these episodes are relieved. Administration
of a tranquilizer may be useful in controlling such
episodes.

Prior to elective surgery, imipramine should be discon-
tinued for as long as the clinical situation will allow.

An activation of the psychosis may occasionally be ob-
served in schizophrenic patients and may require reduc-
tion of dosage and the addition of a phenothiazine.

In occasional susceptible patients or in those receiving
anticholinergic drugs (including antiparkinsonism agents)
in addition, the atropine-like effects may become more
pronounced (e.g., paralytic ileus). Close supervision and
careful adjustment of dosage is required when this drug is
administered concomitantly with anticholinergic or sym-
pathomimetic drugs.

Avoid the use of preparations, such as decongestants
and local anesthetics, which contain any sympathomime-
tic amine (e.g., adrenalin, noradrenalin), since it has been
reported that tricyclic antidepressants can potentiate the
effects of catecholamines.

Patients should be warned that the concomitant use of
alcoholic beverages may be associated with exaggerated
effects.

Both elevation and lowering of blood sugar levels have
been reported.

Concurrent administration of imipramine with electroshock
therapy may increase the hazards; such treatment should
be limited to those patients for whom it is essential, since
there is limited clinical experience.

Adverse Reactions: Note: Although the listing which fol-
lows includes a few adverse reactions which have not
been reported with this specific drug, the pharmacological
similarities among the tricyclic antidepressant drugs re-
quire that each of the reactions be considered when imip-
ramine is administered.

Cardiovascular; Hypotension, hypertension, tachycardia,

palpitation, myocardial infarction, arrhythmias, heart block,

stroke, falls.

Psychiatric: Confusional states (especially in the elderly)
with hallucinations, disorientation, delusions; anxiety,
restlessness, agitation; insomnia and nightmares;
hypomania; exacerbation of psychosis.

Neurological: Numbness, tingling, paresthesias of ex-
tremities; incoordination, ataxia, tremors; peripheral
neuropathy; extrapyramidal symptoms; seizures, altera-
tions in EEG patterns; tinnitus.

Anticholinergic: Dry mouth, and, rarely, associated sub-
lingual adenitis; blurred vision, disturbances of accommo-
dation, mydriasis; constipation, paralytic ileus; urinary re-
tention, delayed micturition, dilation of the urinary tract.
Allergic: Skin rash, petechiae, urticaria, itching, photosen-

sitization (avoid excessive exposure to sunlight); edema
(general or of face and tongue); drug fever; cross-
sensitivity with desipramine.

Hematologic: Bone marrow depression including agran-
ulocytosis; eosinophilia; purpura; thrombocytopenia.
Leukocyte and differential counts should be performed in
any patient who develops fever and sore throat during
therapy; the drug should be discontinued if there is evi-
dence of pathological neutrophil depression.
Gastrointestinal: Nausea and vomiting, anorexia, epigas-
tric distress, diarrhea; peculiar taste, stomatitis, abdominal
cramps, black tongue.

Endocrine: Gynecomastia in the male; breast enlarge-
ment and galactorrhea in the female; increased or de-
creased libido, impotence; testicular swelling; elevation or
depression of blood sugar levels.

Other: Jaundice (simulating obstructive); altered liver
function; weight gain or loss; perspiration; flushing; uri-
nary frequency; drowsiness, dizziness, weakness and
fatigue; headache; parotid swelling; alopecia.

Withdrawal Symptoms: Though not indicative of addiction,
abrupt cessation of treatment after prolonged therapy
may produce nausea, headache and malaise.

Dosage and Administration: |n adult outpatients,
therapy should be initiated on a once-a-day basis with 75
mg./day. This may be increased to 150 mg./day which is
the dose level which usually obtains optimum response. If
necessary, dosage may be increased to 200 mg./day.
Dosage should be modified as necessary by Clinical re-
sponse and any evidence of intolerance. Daily dosage
may be given at bedtime, or in some patients in divided
daily doses.

Hospitalized patients should be started on a once-a-day
basis with 100-150 mg./day and may be increased to 200
mg./day. Dosage should be increased to 250-300 mg./day
if there is no response after two weeks.

Following remission, maintenance medication may be re-
quired for a longer period of time at the lowest dose that
will maintain remission. The usual adult maintenance
dosage is 75-150 mg./day on a once-a-day basis, prefer-
ably at bedtime.

In adolescent and geriatric patients, capsules of Tofranil-
PM, brand of imipramine pamoate, may be used when
total daily dosage is established at 75 mg. or higher. It is
generally unnecessary to exceed 100 mg./day in these
patients. This dosage may be given once a day at bed-
time or, if needed, in divided daily doses.

How Supplied: Tofranil-PM, brand of imipramine
pamoate: Capsules of 75, 100, 125 and 150 mg. (Each
capsule contains imipramine pamoate equivalent to 75,
100, 125 or 150 mg. of imipramine hydrochloride.)

(B) 98-146-840-A(9/75) 667120

For complete details, including dosage and adminis-
tration, please refer to the full prescribing informa-
tion.

GEIGY Pharmaceuticals
Division of CIBA-GEIGY Corporation
Ardsley, New York 10502

SA 11472

MeWTs

GILPIN PURCHASES THE
JOHN B. DANIEL COMPANY

James E. Allen, Chairman and President of the Henry B.
Gilpin Company recently announced the company’s acquisi-
tion of the John B. Daniel Company, Inc. from the Cenco
Medical Industries Corporation.

Charles C. Wilson, an experienced wholesale drug ex-

ecutive and former Treasurer and Operations Manager of

John B. Daniel, Inc., has been promoted to Vice President
and General Manager. Mr. Robert L. Garges has retired as
President of the John B. Daniel Company to devote more
time to his personal interests. Mr. Allen stated that Gilpin is
pleased that Mr. Garges will serve as a consultant to the John
B. Daniel Company and maintain his interest in the firm.

With headquarters in the nation’s capital, The Henry B.
Gilpin Company now operates seven full service wholesale

Reserve the date now . .

drug houses, located in: Atlanta, Georgia; Baltimore,
Maryland; Dover, Delaware; Indianapolis, Indiana;
Memphis, Tennessee; Norfolk, Virginia; and Washington,
D.C. in addition to its surgical supply and service merchan-
dising subsidiaries in Virginia, Maryland, and Indiana.

CHANGE OF ADDRESS

When you move—

Please inform this office four weeks in advance to avoid
undelivered issues.

"The Maryland Pharmacist'' is not forwarded by the Post
Office when you move.

To insure delivery of ''The Maryland Pharmacist’ and all
mail, kindly notify the office when you plan to move
and state the effective date. APhA members—please in-
clude APhA number.

Thank you for your cooperation.

Nathan |. Gruz, Editor
Maryland Pharmacist

650 West Lombard Street
Baltimore, Maryland 21201

AUGUST 1-2-3

Maryland’s Largest Show for 1976

F. A. DAVIS & SONS, INC.
FALL & HOLIDAY SHOW

. Many Prizes
. Evening Buffet
. Show Specials

NM PWN

Place: MARTIN'S WEST

Time: Sunday, August | ....
Monday, August 2 ...
Tuesday, August 3 ...

MAY 1976

epee Nile een ee ee ret. 0, IM:

Over 100 Leading Manufacturers Represented
. Thousands of Profitable Products
. Unusual New Items, Toys, Cosmetics and Gifts

— off Beltway Exit 17

betes Miri Or) OP Vie

| P.M#to 10 P.M.

THE MARYLAND PHARMACIST 11

te

prices
rsys

y match our

Afewma
Butnoonecan beat ou

©
‘ caiaanittedeelai ities came,

SON GRRE Eten cuinie!

We’re not fooling ourselves.

Gilpin’s grown as much as it has in
the past 130 years because we've beat a
lot of people on price. And we're not
about to change now.

The problem is, a lot of items these
days will cost the same at virtually all
wholesalers. So now we’re not talking
just price.

~ Now we're talking Datarex®

Datarex® is a
completely auto-
mated, inventory
management system
designed to cut your
labor costs while
increasing your sales
and profits. Individualized to your exact
specifications, your Datarex® system will
be as extensive or as limited as you want
it to be.

Beating the high cost of yesterday’s
prices.

It’s been estimated that the average
pharmacy loses up to 2% of its bottom-
line profits because its price stickers
have failed to keep pace with inflation-
ary changes.

Datarex® makes all the adjustments
automatically. Automatically.

The hole in your shelf, the drop in
your curve.

We found out
something else oe
about the average _
pharmacy: it loses #]™
up to 15% of its
possible sales
because of aig NEE aayitiy eee

Datarex® puts an end to outs.

Coded shelf labels work in con-
junction with the computerized in-store
ordering terminal and the Datarex”
CRT order-entry system to keep you
in-stock. All the time.

DUMFRIES
OUR

:
Should you be doing what you're doing?

Right now you're probably spending
a lot of your time checking stocks,
ordering and filling shelves.

What you should be doing is
managing.

In minutes, anyone in your store can
be running the whole system, freeing
your management team to do the jobs
that build your profits.

Sound expensive? Wrong.
- A Datarex® system can cost as little
as $50 a month.

You see, we're a total-service whole-
saler, and we want all your business. All
of it. So we know we can’t afford to
charge you too much for any one service
—even a service like Datarex*

As we said, we’re not fooling
ourselves.

You can’t beat the system:
The Datarex® system from Gilpin.

7 aay

THE HENRY B. LEG

GILPIN

COMPANY
901 Southern Avenue
Washington, D.C. 20032
Phone (301) 630-4500

Attention Harrison L. Leach
Vice President Retailer Services

I want to know more about the |
system. Send me your free Datarex”
booklet.

Name

Firm

Address

City * : State Zip _

i Z LICR oe eee

14

institutional
OlNeAMeCY|

CONTAMINATION INCIDENCE IN
AN IV ADMIXTURE PROGRAM

By Peter P. Lamy and Tuong Nguyen

Introduction

Septicemia, with sometimes fatal results, has been
reported due to non-sterile intravenous solutions and the use
of contaminated administration sets (1, 2). Contamination
rates of IV solutions and admixtures fluctuating from one to
38 percent have been reported varying with the types of
systems studied (glass or plastic), the testing condition, the
testing techniques and the materials used.

Theoretically, therefore, each IV admixture should be
tested for sterility before it reaches the patient. This, of
course, is not feasible. Testing requires often 24 to 48 hours,
precluding the immediate implementation of the physician’s
treatment plan.

Thus, it is important that each laboratory at a minimum
periodically determine its level of efficiency as far as sterility
is concerned.

Purpose

The purpose of this study was to establish a quality
assurance program to monitor through sterility testing, both
intravenous admixtures immediately after preparation in the
IV laboratory and during fluid administration.

Methodology

All equipment involved in the testing procedure was tested
for conformity with Federal Standard 209a (11). Rates of air
flow within the laminar flow units were measured with a
thermo-anemometer. H.E.P.A. filters were tested by the use

Tuong A. Nguyen, M.S., is Assistant Manager, Store #14, Read’s
Drugstores Inc., Baltimore, Maryland 21206. At the time of the study,
she was a pharmacy resident at Maryland General Hospital,
Baltimore, Maryland 21201 and a graduate student, Institutional
Pharmacy Programs, at the University of Maryland, School of
Pharmacy.

Peter P. Lamy, Ph.D., F.C.P. is a Professor of Pharmacy, and
Director of Institutional Pharmacy Programs, University of Maryland
School of Pharmacy and the University of Maryland Hospital,
Baltimore, Maryland 21201.

This article was abstracted from a thesis submitted in the Graduate
School of the University of Maryland in partial fulfillment of the
requirements for the Master of Science degree.

THE MARYLAND PHARMACIST

of a particle counter. Microbial contamination levels inside
the units were also determined by the impaction on solid:
surface air sampling method (3).

The study was conducted at a large core city hospital
which prepares approximately 150,000 IV admixtures per
year. Using a commercially available thioglycollate medium,
the testing was performed on:

1. new and unused IV fluids and administration sets
(controls)

2. IV admixtures prepared by the pharmacy before
they left the IV laboratory, and

3. IV admixtures and administration sets sampled at
bedside during fluid administration to the patient.

All samples were prepared in a horizontal laminar flow
unit with the exception of samples obtained at the patient’s
bedside from in-use bottles and administration sets. The
investigator observed strict aseptic techniques during all
sampling procedures. During the course of the study,
prefilters of the laminar flow units were changed every two
months.

The thioglycollate medium (BBL a) was obtained packed
under vacuum and sealed with a rubber stopper. This
permitted the safe inoculation with samples collected right in
the patient care areas. Fluid Thioglycollate Medium, U.S.P.
was chosen as the sole medium for both bacteria and fungi as
it is capable of supporting aerobes, anaerobes, and fungi.
Deeb and Natsios (4) successfully demonstrated fungi
proliferation in this medium. The U.S.P. sterility test (5)
recommends 80 ml. of medium for testing at least 10 ml. of
the product if the content of the container (i.e., [V bottle) is
greater than 50 ml.

Throughout the study, all cultures as well as controls were
incubated at 35°C for at least 7 days. For purpose of
identification, subcultures were prepared on blood agar
medium and routine procedures for identification of
organisms were followed with the assistance of the Infectious
Diseases Division and Bacteriology Laboratory of the study
hospital.

MAY 1976

In all phases, a positive control procedure of the medium
was performed by injecting 0.1 ml. each of very dilute E. coli
(an aerobe), B. fragealis (an anaerobe), and A. Fumigatus (a
fungi) suspension, into each bottle containing the test
medium. Growth determined by turbidity of the medium
indicated the adequacy of the thioglycollate medium.
Negative controls were obtained by incubating sterile bottles
containing the test medium to which no inoculum had been
added.

Table I depicts the study solutions used. Administration
sets used included standard administration sets, Y type sets,
sets with calibrated chamber, and central venous pressure
manometer.

Testing of Controls: Control samples of IV _ solutions
consisted of 10 ml. of fluid from unused IV bottles chosen
from the active stock and added to the test medium.

Testing of IV Admixtures Prepared by the Pharmacy:
Samples of IV admixtures were obtained from the IV
laboratory and decentralized pharmacies. These included
freshly prepared admixtures as well as those which were
returned unused and unopened from the patient care areas.
Samples were collected in a horizontal laminar flow unit by
withdrawing a single 10 ml. aliquot using a disposable
syringe with a 20 gauge needle. This was added to the
medium bottle through its rubber stopper diaphragm. Prior
to all sampling the IV bottle tops were cleansed with 70
percent isopropyl alcohol.

Testing of In-Use Solutions, Admixtures and Administra-
tion Sets: In-use fluids were randomly collected at the
patient’s bedside when the bottles were approximately half-
empty. Samples were obtained in the Medical Patient Care
Units, in the acute Stoke and Intensive Care Units, and in the
Institute of Emergency Medicine. Half of the bottles tested
had been prepared on the patient care areas by nursing
personnel. Some of these did not contain additives. The
other half had been prepared by the pharmacy.

The sampling of in-use IV bottles was performed by
withdrawing a 10 ml. aliquot through the medication port of
the seal, using a 10 ml. sterile disposable syringe with a 20
gauge needle. Before inserting the needle, the area surroun-
ding the medication port was cleansed with 70 percent
isopropyl alcohol. Care was taken to avoid touching the
spike with the sterile needle. The sample was added to the
commercially available medium through its rubber stopper
seal.

MAY 1976

THE MARYLAND PHARMACIST

In-use IV sets were tested for contamination as follows:

1. The lower part of the tubing between the area near the
Y-injection site and the patient arm was clamped, and the
upper clamp controlling the flow rate was released.

2. A 10 ml. sample of the 1V fluid was withdrawn from the
Y-injection site, using a sterile disposable syringe with a 20
gauge needle. Prior to this, the Y-injection site was cleansed
with 70 percent isopropyl alcohol.

3. The sample was added to the medium as outlined
above.

4. The lower IV clamp was released and the upper clamp
adjusted for normal fluid flow.

Results
Experimental Results

Of 197 pharmacy-prepared admixtures tested, none show-
ed any growth (Table II). The sterility of admixtures was also
shown to be maintained over a period of two months under
refrigeration.

IV admixutres and IV sets tested during administration to
the patient showed a very low contamination rate (Table II).
Of 168 in-use fluids, only one bottle prepared by nursing
personnel and one set were found to be contaminated. Both
were contaminated with anaerobic Gram positive cocci,
suggestive of touch contamination rather than airborne
contamination. It is interesting that no hyperalimentation
solution was found to have been contaminated. This seems
to contradict Deeb and Natsios’s report (4) of a higher rate of
contamination found in hyperalimentations compared to
the more conventional solutions.

The total absence of growth in the control admixtures
verifies that the containers were sterile prior to use and that
the sampling techniques and culturing methods were proper-
ly performed.

Comments

While this particular study showed a very acceptable level
of quality assurance, other contamination values range from
zero to 38 percent (6-10). Reports thus vary widely,
depending upon the conditions under which the studies were
conducted, the sample size, the testing techniques, and
methods used. Thus, it is apparent that hospital pharmacists
must establish routine tests of IV admixtures.

Large volume parenterals, in addition to being sterile,
must also be progen-free. It is necessary to set up a quality
assurance program for the detection of pyrogens on the same
basis as a quality assurance program for the detection of
viable contaminants.

(Continued on page 22)

15

Septra DS. The same reliable formulation

but doubled in tablet strength, lower in cost.

For patients with recurrent
urinary tract infections

Septra DS the same Septra
efficacy in recurrent cystitis,
pyelitis, and pyelonephritis due to
susceptible organisms

Septra DS: the same Septra

spectrum—E coli, Klebsiella-
Enterobacter, P mirabilis, P vulgaris,
P morganii

Septra DS: the same b.i.d.

dosage schedule, but one tablet
instead of two

Indications: Chronic urinary tract infections evidenced by persistent
bacteriuria (symptomatic or asymptomatic), frequently recurrent infec-
tions (relapse or reinfection), or infections associated with urinary tract
complications, suchas obstruction. Primarily for cystitis, pyelonephritis or
pyelitis due to susceptible strains of F coli, Klebsiella-Enterobacter,
Proteus mirabilis, Proteus vulgaris and Proteus morganii.

NOTE: The increasing frequency of resistant organisms limits the useful-
ness of antibacterials, especially in these urinary tract infections.

The recommended quantitative disc susceptibility method (Federal Regis-
ter 37; 20827-20529, 1972) may be used to estimate bacterial suscepti-
bility to Septra. A laboratory report of “Susceptible to trimetho-
prim-sulfamethoxazole’ indicates an infection likely to respond to Septra
therapy. ‘Intermediate susceptibility’ also indicates that response is likely
and “Resistant” that response is unlikely.

Contraindications: Hypersensitivity to trimethoprim or sulfonamides;
pregnancy; nursing mothers.

Warnings: Deaths from hypersensitivity reactions, agranulocytosis,
aplastic anemia and other blood dyscrasias have been associated with
sulfonamides. Experience with trimethoprim is much more limited but
occasional interference with hematopoiesis has been reported as well as
an increased incidence of thrombopenia with purpura in elderly patients on
certain diuretics, primarily thiazides. Sore throat, fever, pallor, purpura or

jaundice may be early signs of serious blood disorders. Frequent CBC’s are
recommended; therapy should be discontinued if a significantly reduced
count of any formed blood element is noted. At present, data are insufficient
to recommend use in infants and children under 12.

Precautions: Use with caution in patients with impaired renal or hepatic

function, possible folate deficiency, severe allergy or bronchial asthma. In

glucose-6-phosphate dehydrogenase deficient individuals, hemolysis may

occur (frequently dose-related). During therapy, maintain adequate fluid
intake and perform frequent urinalyses, with careful microscopic examina-

pol, and renal function tests, particularly where there is impaired renal
unction.

Adverse Reactions: All major reactions to sulfonamides and trimethoprim
are included, even if not reported with Septra. Blood dyscrasias. Agranulo-
cytosis, aplastic anemia, megaloblastic anemia, thrombopenia, leuko-
penia, hemolytic anemia, purpura, hypoprothrombinemia and
methemoglobinemia. Allergic reactions: Erythema multiforme, Stevens-
Johnson syndrome, generalized skin eruptions, epidermal necrolysis,
urticaria, serum sickness, pruritus, exfoliative dermatitis, anaphylactoid
reactions, periorbital edema, conjunctival and scleral injection, photosen-
sitization, arthralgia and allergic myocarditis. Gastrointestinal reactions:
Glossitis, stomatitis, nausea, emesis, abdominal pains, hepatitis, diarrhea
and pancreatitis. CNS reactions: Headache, peripheral neuritis, mental
depression, convulsions, ataxia, hallucinations, tinnitus, vertigo, insomnia,
apathy, fatigue, muscle weakness and nervousness. Miscellaneous reac-
tions: Drug fever, chills, toxic nephrosis with oliguria and anuria, periar-
teritis nodosaandL.€. phenomenon. Due tocertain chemical similarities to
some goitrogens, diuretics (acetazolamide, thiazides) and oral hypogly-

cemic agents, sulfonamides have caused rare instances of goiter produc-
tion, diuresis and hypoglycemia; cross-sensitivity may exist with these
agents. In rats, long-term therapy with sulfonamides has produced thyroid
malignancies.

Dosage: Not recommended for children under 12. Usual adult dosage: 1
SeptraDS tablet or 2 Septraplain tablets or 4 teaspoonfuls (20 ml) every 1 2
hours for 10 to 14 days. Shake suspension well before using.

For patients with renal impairment:

Creatinine Clearance (ml/min)
Above 30
15-30 1 DS tablet, 2 tablets or 4 teaspoonfuls
(20 mil) every 24 hours

Supplied: Septra DS (Double Strength) tablets containing 160 mg trimeth-
oprim and 800 mg Ae bottles of 60 tablets. Septra tablets
containing 80 mg trimethoprim and 400 mg sulfamethoxazole — bottles of
40, 100, 500, and 1000 tablets and strip packages of 100 individually
packed tablets. Oral suspension, containing the equivalent of 40 mg
trimethoprim and 200 mg sulfamethox- Burroughs Wellcome Co.
azole in each teaspoonful (5 ml), cherry Research Triangle Park
flavored—bottles of 450 ml. North Carolina 27709

Recommended Dosage Regimen

Usual standard regimen

Wellcome

U.S.P. DRUG PRODUCT PROBLEMS REPORT

Reported by the United States Pharmacopeial Convention

The following are some of the recalls, product im-
provements, and explanations resulting from the Drug
Product Defect Reporting Program.* The product and
company names have intentionally been omitted; and no
reflection on any specific manufacturer, distributor, phar-
macist, or product is intended or should be inferred from the
case studies. It is hoped that these examples will indicate the
type of results which this program can bring about, as well as
indicating to the pharmacist reader some of the areas where
he or she may want to be alert; e.g.: Package insert
information, package designs, labeling, unusual or improper
drug product appearance.

A. “Pediatric” Designation Removed from Name

In response to reports concerned about the possibility of
confusion over the designation as “pediatric” of the stronger
of the two liquid dosage forms of an asthma preparation, the
manufacturer has agreed to remove the designation. Ap-
parently, the term “pediatric” in the name of the liquid
suspension led several pharmacists to feel that it should be
the less potent of the two. In fact, the “pediatric” preparation
was twice as potent as the other elixir form; furthermore, it
was sometimes used by adults. The new labels are already in
production.

B. Salicylic Acid Recalled

Discolored salicylic acid crystals were reported by phar-
macists in New Jersey and Massachusetts. An FDA follow-
up investigation at the firm revealed that several quality
control deficiencies existed. Further, after retesting the drug,
the firm confirmed that it did not meet USP specifications.
The company initiated a voluntary recall of the lot involved
and promised corrective action on the noted control
deficiencies.

C. Package Insert Revised

Complaining “Doesn’t anyone read these anymore?,” a
report submitted by a New York state community phar-
macist pointed out that the Clinical Pharmacology and
Physical and Psychological Sections of a package insert for
an anti-anxiety drug were confusing and contradictory.
After reviewing the insert, the manufacturer agreed with the
pharmacist’s comments and is instituting a revision of the
insert to clarify the intended meaning.

THE MARYLAND PHARMACIST

D. “Swollen Stoppers” Resulted in
Processing Modification

Swollen stoppers on vials of sterile light mineral oil
intended for use as a lubricant were reported bya California
hospital pharmacist. Analysis, sterility testing, and testing
for presence of any gas formation were done by the
manufacturer which showed no evidence that the mineral oil
was unsuitable for use. However, the manufacturer does
plan to modify their processing to eliminate this problem
from future lots. The firm’s response to the pharmacist
indicated that the swelling was probably caused by absorp-
tion of a small quantity of mineral oil into the stopper.

E. Subpotent Birth Control Tablets Recalled

We believe that a report submitted by a Wisconsin
community pharmacist was instrumental in leading to the
recall of an oral contraceptive agent by the manufacturer.
The pharmacist noted that the tablets were fading when
exposed to light. Assay of the returned stock revealed that
the ingredient, ethinyl estradiol, was below claimed potency.

F. Applicator Redesigned to Eliminate
Broken Glass Contact

New production procedures will be instituted by the
manufacturer of unit dose applicators of Green Soap
Tincture, N.F. following a Drug Product Defect Report
submitted by a blood bank supervisor in a New York City
hospital. She had noted three deficiencies: 1) No lot number
on the plastic containers. 2) Contents evaporated in some
units. 3) Smashed glass particles came into contact with
patients following crushing of the unit for application to
patient’s skin.

The firm has recognized these deficiencies and has
instituted new production procedures to place the lot
number on each unit and is implementing new design
features for the plastic units in an effort to overcome the
other two problems.

G. Caking Ophthalmic Corticosteroid Suspension
“STORE UPRIGHT?” will be added to the label of each
bottle of an ophthalmic suspension by the manufacturer who

*The work upon which this publication is based was
performed by the USP Convention pursuant to Contract
No. FDA 223-72-3088 with the Public Health Service, Food
and Drug Administration, Department of Health, Educa-
tion and Welfare.

MAY 1976

concurred with a Pennsylvania pharmacist’s observations.
When the bottle was not shipped or stored in an upright
position, the suspension became caked to the top of the
container and could not be shaken loose. The pharmacist’s
report suggested that if the active ingredient was in this solid
cake, this could result in patients not getting the proper dose.

H. OTC Cough Syrup Reformulated

An lowa community pharmacist who had reported a
“milky layer” on top of a popular OTC liquid cough
preparation sent USP a copy of the reply which he had
received from the manufacturer. It indicated that, on
analysis, the floating precipitate was identified as sorbic
acid, an antimicrobial preservative. Although the firm stated
that the safety and efficacy of the product were not affected
and that it was only an esthetic situation, they reformulated
the cough syrup to eliminate the problem.

I. One Product Labeled as Two

Two California community pharmacists reported that
they had received stock of an OTC cough syrup labeled as
one product on the front and a different product on the back.
An inspection of the firm’s entire inventory stock found
additional mislabeled units. The company plans to destroy
all mislabeled stock.

J. Package Insert Revised

An astute Wisconsin community pharmacist noted that
the package insert dosage and administration directions for
an anthelmintic preparation were confusing. As the product
is covered by a New Drug Application (NDA), the report
was reviewed by officials in the NDA branch of the Food and
Drug Administration who agreed with the pharmacist and
directed the manufacturer to revise the package insert.

K. Capsule Source Changed

“Sorbitol bloom” was the explanation given for a white
powder forming on the surface of dioctyl sodium sulfosuc-
cinate capsules. The manufacturer informed the Arizona
hospital pharmacist, who had reported the powder-covered
capsules, that their capsule vendor has used sorbitol in the
formulation of the soft gelatin capsules primarily to prevent
breakdown of the gelatin by the active ingredient. The
manufacturer indicated that because of this problem, he
would fill future orders with capsules obtained from another
source.

L. Antihistamine Tablets Recalled

Differences in the ingredients statements on the bottle
label and the package insert of an antihistamine preparation
precipitated a report froma Brooklyn, N.Y. pharmacist. The
manufacturer initiated a recall of the lot involved after the
discrepancy was confirmed by an FDA follow-up investiga-
tion. The firm had used old package inserts which did not list
the current ingredients.

MAY 1976

THE MARYLAND PHARMACIST

M. Anti-Diarrheal Mixture Recalled

A community pharmacist in New Jersey noted than an
OTC anti-diarrheal mixture was too thick for dispensing.
The manufacturer felt that the problem was possibly due to
product exposure to extreme temperatures, causing the
mixture to jel in the bottles. A recall of the lot was made.

N. Fluoride Oral Rinse Reformulated

A black precipitate in all her stock of a fluoride oral rinse
was reported by a New York state community pharmacist.
The manufacturer investigated the matter and identified the
sediment as dye and flavor material. In the future, the firm
will reduce the quantities of the dye and flavor to avoid the
sedimentation problem.

O. Toluene Labeled as Acetone

A surgeon’s comments to a Pennsylvania hospital phar-
macist that redness and blotchiness resulted when a solvent
labeled as acetone was used to remove bandage adhesive
from patients first called attention to a possible label mixup.
The pharmacist further noted that it did not smell like
acetone and reported the problem. When analysis of a field
sample by FDA revealed the solvent to be toluene, the
manufacturer recalled the lot.

P. Use of Ophthalmic Preparation in Surgery

In response to a Kentucky hospital pharmacist’s report
that their Procaine Hydrochloride Injection was causing an
inflammatory reaction of the eyelids when used in cataract
surgeries, the manufacturer’s vice president of quality
control researched the problem. He replied that, on analysis,
the procaine hydrochloride injection in question met all USP
XIX specifications for the injection. However, he noted that
his company’s product, presented ina multiple dose vial, was
therefore required to contain an antimicrobial preservative.
Benzyl alcohol was being used. Two other manufacturer’s
products, which the pharmacist reported had not caused
inflamation, did not contain benzyl alcohol. The manufac-
turer pointed out that USP XIX, page 703, states that
“Where intended for use in surgical procedures, ophthalmic
solutions, although they must be sterile, should not contain
antimicrobial agents, since they may be irritating to the
ocular tissues.” Based on this statement and other sources,
the manufacturer concluded that the inclusion of benzy!
alcohol in their injection formulation made it inappropriate
for use in cataract surgery.

Q. Bottle Manufacture Contributes to
Particulate Matter

White floating particles in dropper containers of atropine
sulfate 1% ophthalmic solution were reported by a New
Jersey hospital pharmacist. Assays of the atropine sulfate
indicated that it was within specification limits for content
and pH. After extensive testing of samples, the manufacturer

(Continued on page 21)

19

Dear Pharmacist:
This misleading ad

provides reasons
why you should
continue to
dispense ACTIFED

Some hard facts
from the makers
of ACTIFED

TRI-SUDO’ CLAIM: TRI-SUDO*® Syrup is a
comparable generic substitute for ACTIFED*

FACT: B.W. Co. Quality Control labs analyzed
TRI-SUDO* Syrup (Lot Nos. 160000 and
160150) and found it did not contain any
triprolidine hydrochloride, one of the two active
ingredients in ACTIFED?

TRI-SUDO’ CLAIM: TRI-SUDO* had the
analytical tests to prove comparability.

FACT: B.W. Co. obtained from a wholesaler
TRI-SUDO’ literature entitled, “Technical Data

Does your generic substitute really
compare to the Major Brand?

TRI-SUDO
does!

ACTIFED ‘ : — , affo ee: 4
| (A | r-sun0
AcTiFED ; SS.
tp

TABLETS

... and we have the analytical tests to
prove it. Ask your wholesaler—
__ he has our product identification
curves, disintegration and dissolution
_. tests plus the pH factor of the syrup.
it tells the story.

“Quality” is not just a word with
MD Pharmaceutical—it's our future!
Dispense TRI-SUDO with confidence.

Now in stock at your wholesaler in
unlimited supply. Order today!

=
€MD Pharmaceutical Inc.

3501 West Garry Avenue, Santa Ana, CA 92704

Study” and found it does not prove compara-
bility. The infra-red absorption spectra shown
in the test results as proof of comparability do
not show triprolidine but the solvent used in
the assay procedure.

CONCLUSION:

Two lots of TRI-SUDO” syrup were
examined by our Quality Control labs
and were found to contain no triproli-
dine, one of the essential ingredients
of our product.

You can be sure of quality controlled
products when you dispense
ACTIFED”® Syrup and Tablets.

For brief summary of prescribing information, please see adjoining column

The decongestant/
antihistamine chosen by
NASA for Apollo, Skylab and
Apollo-Soyuz space missions.

ACTIFED

Tablets and Syrup

Description: Each scored tablet contains
Actidil® brand Triprolidine Hydrochloride
2.5mg and Sudafed* brand Pseudoephed-
rine Hydrochloride 60 mg. Each 5 cc tea-
spoonful of the syrupt contains Actidil®
brand Triprolidine Hydrochloride 1.25 mg
and Sudafed® brand Pseudoephedrine
Hydrochloride 30 mg

+Preservatives: sodium benzoate 0.1%,
methylparaben 0.1%

Indications: Based ona review of this
drug by the National Academy of Sci-
ences—National Research Council
and/or other information, FDA has
classified the Indications as follows:
“Probably” effective: For the sympto-
matic treatment of seasonal and peren-
nial allergic rhinitis and vasomotor
rhinitis.

“Lackingsubstantial evidence of effec-
tiveness as a fixed combination”: For
the prophylaxis and treatment of the
symptoms associated with the com-
mon cold.

Final classification of the less-than-
effective indications requires further
investigation.

Precautions: Although pseudoephedrine
hydrochloride is virtually without pressor
effect in normotensive patients, it should
be used with caution in patients with hyper-
tension. In addition, even though triproli-
dine hydrochloride has a low incidence of
drowsiness, appropriate precautions
should be observed
Adverse Reactions: The great majority of
patients will exhibit no side effects. How-
ever, certain patients may exhibit mild
stimulation or mild sedation—no serious
side effects have been noted.
Dosage and Administration:
SYRUP
teaspoon-
JWNBUERS iS (aCe)
Adults andchildren

over 6 years of age. .1 2
Children 4 months 3 3
through 6 years times times
MAGE ssiese «0 005 “% a | a
Infants up to 4 day day
months of age----- - %

How Supplied:

ACTIFED® TABLETS Bottles of 100 and
1000, bottles of 30 with child resistant cap.
ACTIFED® SYRUP Bottles of 1 gallon, 1 pint,
and bottles of 4 oz with child resistant cap.

Burroughs Wellcome Co.
Research Triangle Park
Wellcome | North Carolina 27709

A-200 PYRINATE KILLS'EM DEAD.

Why bother stocking anything else?

Crabs, head and body lice, nits — the
only medicine anyone needs to stop them
dead is A-200 Pyrinate, the No. 1 lice
killer. It has the highest turnover rate of
any pediculicide.

At $2.29 suggested retail, A-200
Pryinate means excellent profit for you.
And it’s non-prescription, which means
good walk-in business. It’s advertised in
college and underground papers. And this
year, the Lice Alert Hotline Program will
make people more aware than ever of
A-200 Pynnate.

Stock both forms of A-200 Pyrinate.
The Liquid is ideal for head lice. The Gel
is convenient for children,
and for treatment of crab
lice in the pubic and
hard-to-reach pen-
anal areas.

A-200 Pyrinate

is the Pharmacists’ Pediculicide. It’s the
only lice remedy you need to stock. Dis-
play it in the medicated shampoo section
for impulse purchase, and behind the
counter for your own recommendation.
LICE ALERT HOTLINE: When
lice strike, call us toll free at 800-431-1140.
Once the outbreak is verified, we'll
swing into action with a whole program
designed to stop an outbreak before it
gets rolling. And to thank you for your
quick thinking, we'll send
youa gift you can use in gravee
your professional
practice. _ “

No. 1
Lice Medicine

PRODUCT PROBLEMS

(Continued from page 19)

identified the white amorphous solids as esters of a long
chain fatty acid, which may be attributable to the agent used
to release the container from its mold during manufacturing.
The firm appreciated having had the problem brought to

their attention.

R. Change to Paper Labels

“Labeling is difficult to read and appears to be wearing
off’ was the comment received froma hospital pharmacist in
Connecticut regarding ampuls of an electrolyte solution. As
a result of this report and reports from other pharmacists,
the manufacturer is converting to a paper label which they
feel will be more legible and will be able to withstand the

wear of handling.

INSTITUTIONAL PHARMACY

(Continued from page 15)

References

|. Ashcroft, K. W. and Leape, L. K.: Candida Sepsis
Complicating Parenteral Feeding, J. Amer. Med. Assoc.,

212: 454-456 (1970).

2. Duma, R. J., Warner, J.

284: 257-260 (1971).

TABLE I

LIST OF SOLUTIONS STUDIED
Dextrose Injection, U.S.P., 5%
Dextrose Injection, U.S.P., 10%
Sodium Chloride Injection, U.S.P., 0.45%
Sodium Chloride Injection, U.S.P., 0.9%
Dextrose and 0.2% Sodium Chloride Injection, U.S.P., 5%
Dextrose and 0.45% Sodium Chloride Injection, U.S.P.,5%
Dextrose and 0.9% Sodium Chloride Injection, U.S.P., 5%
Dextrose and 0.2% Sodium Chloride Injection, U.S.P., 10%
Dextrose and 0.9% Sodium Chloride Injection, U.S.P., 10%
Lactated Ringer’s Injection, U.S.P.
Lactated Ringer’s (Hartmann’s Solution) with 5% Dextrose

Amigen (Protein Hydrolysate Injection, U.S.P. - Casein)
Injection, 5%

Dextrose Injection, U.S.P., 50%

F. and Dalton, H. P.:
Septicemia from Intravenous Infusions, New Engl. J. Med.,

3. Hall, L. B. and Decker, H. M.: IV Procedures
Applicable to Sampling of the Environment for Hospital
Use. Amer. J. Public Health, 50: 491-496 (1960).

4. Deeb, E. and Natsios, G.: Contamination of In-
travenous Fluids by Bacteria and Fungi during Preparation
and Administration, Amer. J. Hosp. Pharm., 28: 764,
(1971).

5. United States Pharmacopeia, 18th ed., Mack Com-
pany, Easton, Pennsylvania, 1970, p. 851-857.

6. Arnold, T. R. and Helpler, C.: Bacterial Contamina-
tion of Intravenous Fluids Opened in Unsterile Air, Amer. J.
Hosp. Pharm., 28: 614-618, (1971).

7. Hanson, A. J., Nighswander, R. and Verhulst, J. H.:
Monitoring of Intravenous Solutions, Hosp. Formul.
Manage., 8: 17-21, (1973).

8. Steckel, S. D., Gonik, M., Martens, PP.) Pately Je
Curtis, E. and Ho, N.: Kinetics of Microbial Growth in Bulk
Parenteral Solutions I. S. faecalis and B. subtilis in
Dextrose-Saline and Hyperalimentation Solutions, Drug
Intell. Clin. Pharm., 7: 177-182, (1973).

9. Miller, W. A., Smith, G. L. and Latiolais, C. J.:
Compounding Costs and Contamination Rates of In-
travenous Admixtures, Drug Intell. Clin. Pharm., 5: 51-60,
(LOTT):

10. Sterility Testing of Intravenous Solutions, Memoran-
dum from Judith Scott, Surgical Bacterilogy Laboratory, to
Peter Bent Brighman Hospital Nursing Staff, Boston, Mass.
(Nov. 1972).

TABLE II

CONTAMINATION OF IV SOLUTIONS, ADMIXTURES AND
SETS TESTED BEFORE AND DURING FLUID ADMINISTRATION

Tested Samples

Number Contaminated/ Total Number Tested

Contamination Incidence

Contamination %

Control Solutions 0/ 100 —

Pharmacy Admixtures

(before fluid administration)
Hyperalimentation 0/67 ==
Dextrose-Saline 0/ 130 —_

In-Use Admixtures

(during fluid administration)
IV Bottles 1/84 l
IV Sets 1/84 i)

aBBI Bioquest Biological Laboratories, Division of Bechton-
Dickinson and Co., Cockeysville, Maryland.
22 THE MARYLAND PHARMACIST MAY 1976

at Alibee withC a
MULTIVITAMINS 3 i

Each capsule contains: % MPR

Thiamine ;
: mononitrate (By). 15 mg 1500%
Allbeewi } } Riboflavin (B:) 10mg 834%
MINS Pyridoxine
MULTIVITAMINS hydrochloride (By) 5Smg *
Miacinamide 50 mg ,
Calcium pantothenate 10mg = **
< Ascorbic
ne onenaie nee acid (Vitamin C) 300 mg 1000%
acid (Vitemin C) 300 me

Summ 4-H-
: AH OBINS a

...word of mouth — still No.1in drug store sales!

and this year's

(April 1-
deal:
is bigger and
better than ever!

@ YOU GET MORE FREE GOODS
plus
@ NEW CUSTOMER INCENTIVE PROGRAM

$100 refund consumer coupon
(on the bottle of 100)

Contact your Robins Representative or Wholesaler for all the details!

Put your facings where your profits are!

A-H-[ROBINS A. H. Robins Company, Richmond, Virginia 23220

Big enough to
service you....

Small enough to
know you

Today...as always
...IN quality,
experience, reliability,
Paramount means
personal service and
personal contact!

2920 Greenmount Avenue
Baltimore, Maryland 21218

Phone: Baltimore — 366-1155; Washington (local call) 484-4050

LIBRIUM
(chlordiazepoxide HC)

FOR ALL THE RIGHT
REASONS.

eT : PERFORMANCE. A MATTER OF RECORD

Librium has long been recognized as an effec-
tive and safe antianxiety agent. Patients taking
Librium seldom experience serious side effects or in-
terference with mental acuity (see summary of prod-
uct information on following page for additional
information). Furthermore, Librium has been used
in conjunction with many primary medications.

In dispensing Librium, the pharmacist also
benefits. As the originator and developer of Librium,
Roche Laboratories offers you ready access to the
extensive technical information compiled on this
psychotherapeutic agent over the past 15 years. You
can also take advantage of the additional compli-
mentary services provided by Roche that are rele-
vant to the interests and problems of your profession.

MEDICAL EMERGENCY LINE

One way Roche provides immediate product
information is through the Medical Emergency
Line. Roche maintains this direct, 24-hour tele-
phone service (201-235-2355) for specific questions
concerning Librium or any other Roche product.
For inquiries of lesser urgency, Roche information
specialists will supply detailed responses by mail. Of
course, your Roche representative is prepared to
supply you with a variety of informative materials,
such as scientific brochures, reprints and bibliog-
raphies related to the pharmacology of Librium
(chlordiazepoxide HCl) and its clinical applications.

Aree 201

235-2355

THE NEW ENVIRONMENT OF PHARMACY

‘Two years ago we initiated a highly
— erat hese service —
onment of
Pharmacy. It was designed
by pharmacists for phar-
wit macists. The purpose is
"to keep you informed of
current trends in pharmacy
= ad the changing factors affecting
your profession. Subjects covered include
new government regulations, drug interactions and
new concepts and techniques in pharmacy manage-
ment. If your pharmacy has not already enrolled in this
program, write: The New Environment of Pharmacy,

Roche Laboratories, Division of Hoffmann-La Roche
Inc., P.O. Box 283, Nutley, New Jersey 07110.

LIBERAL
RETURN GOODS POLICY
Although the demand for Librium

minimizes expiration problems for this
product, Roche continues its policy of
expediting replacements of all Roche
products that may be outdated or dis-
continued. This liberal policy enables
you, as a busy pharmacist, to keep your
stock up to date and to maintain a
proper inventory.

LIBRIUM

chlordiazepoxide HC!/Roche

5 mg, 10mg, 25mg capsules

FOR ALL THE PROFESSIONAL
REASONS.

Please consult complete product information,
a summary of which follows:

Indications: Relief of anxiety and tension
occurring alone or accompanying various disease
states.

Contraindications: Patients with known hyper-
sensitivity to the drug.

Warnings: Caution patients about possible
combined effects with alcohol and other CNS
depressants. As with all CNS-acting drugs, caution
patients against hazardous occupations requiring
complete mental alertness (e.g., operating
machinery, driving). Though physical and psycho-
logical dependence have rarely been reported on
recommended doses, use caution in administering
to addiction-prone individuals or those who might
increase dosage; withdrawal symptoms (including
convulsions), following discontinuation of the drug
and similar to those seen with barbiturates, have
been reported. Use of any drug in pregnancy,
lactation or in women of childbearing age requires
that its potential benefits be weighed against its
possible hazards.

Precautions: In the elderly and debilitated,
and in children over six, limit to smallest effective
dosage (initially 10 mg or less per day) to preclude
ataxia or oversedation, increasing gradually as
needed and tolerated. Not recommended in chil-
dren under six. Though generally not recom-
mended, if combination therapy with other
psychotropics seems indicated, carefully consider
individual pharmacologic effects, particularly in
use of potentiating drugs such as MAO inhibitors
and phenothiazines. Observe usual precautions in
presence of impaired renal or hepatic function.
Paradoxical reactions (e.g., excitement, stimula-
tion and acute rage) have been reported in psy-
chiatric patients and hyperactive aggressive
children. Employ usual precautions in treatment of
anxiety states with evidence of impending depres-
sion; suicidal tendencies may be present and
protective measures necessary. Variable effects on
blood coagulation have been reported very rarely
in patients receiving the drug and oral anticoagu-
lants; causal relationship has not been established
clinically.

Adverse Reactions: Drowsiness, ataxia and
confusion may occur, especially in the elderly and
debilitated. These are reversible in most instances
by proper dosage adjustment, but are also occa-
sionally observed at the lower dosage ranges. Ina
few instances syncope has been reported. Also
encountered are isolated instances of skin erup-
tions, edema, minor menstrual irregularities,
nausea and constipation, extrapyramidal symp-
toms, increased and decreased libido—all infre-
quent and generally controlled with dosage
reduction; changes in EEG patterns (low-voltage
fast activity) may appear during and after treat-
ment; blood dyscrasias (including agranulocyto-
sis), jaundice and hepatic dysfunction have been
reported occasionally, making periodic blood
counts and liver function tests advisable during
protracted therapy.

Supplied: Librium® Capsules containing
5 mg, 10 mg or 25 mg chlordiazepoxide HCl.
Libritabs® Tablets containing 5 mg, 10 mg or
25 mg chlordiazepoxide.

Roche Laboratories
Division of Hoffmann-La Roche Inc,
Nutley, New Jersey 07110

A lot of fine products
compete for the custom-
ers dollars, at your phar-

macy. So, when it comes time

\

Our product is periodicals— magazines
and paperback books — and we continually
supply your racks with a variety of current
reading material appealing to every taste and
keeping your customer reader interest at its
highest.

We understand that turnover is important.

With periodicals you have a sufficient new
product each month to stimulate traffic not
only for our product, but for al// the products
in your store.

An investment of $100 in periodicals,
normally will result in $127 of sales within 30

=
COMPANY is well aware of your needs. ©

Ze

days. Not bad! Then
WY think of all the other
/ products you will sell.
Further, since all unsold
copies of our product are return-
able for credit, there is absolutely
no risk.
But perhaps the most important fact
is that periodicals have an unselfish way of
helping to sell every other product in your
store. Take a look at the pages of our maga-

zines and see how they showcase just about

every other product that you sell over and
over again. It is like having a built-in
salesman.

To learn how you can really “help your-
shelf,’ why not give us a Call;
The Maryland News Distributing Co.
(301) 233-4545
Ask about periodicals, the unselfish product.

Eloiituaries
MPhA Member

Mr. Frank F. Levay, owner and operator of Levay’s
Pharmacy at Fort and Riverdale Avenues since 1940, died
on April 14, 1976 at South Baltimore General Hospital after
suffering a heart attack.

A native of Baltimore, Mr. Levay was a graduate of
Loyola College and a 1940 graduate of the University of
Maryland School of Pharmacy. Long active in both civic,
professional, and fraternal organizations, Mr. Levay was a
member of the Maryland Pharmaceutical Association, the
Knights of Columbus, the Glen Burnie Moose Lodge, the
Kiwanis Club of South Baltimore, the Optimist Club of
South Baltimore and the Stony Creek Democratic Club.

He is survived by his wife, the former Helen M. Akonom;
a son, Francis J. Levay, of Riviera Beach; two daughters,
Mrs. Mary R. Cole, of Baltimore, and Mrs. Helen U. Von
Protz, of San Diego; a sister, Mrs. Myra Mason, of
Baltimore, and four grandchildren.

Two new firsts from District Photo!

Vv PLOT]

Turns snapshots into personalized picture postcards and greet- ye
ing cards. Encourages customers to order extra prints — those

to mail, those to keep.

PLUS FOTO-DATE Puts the date on the back of each

print, to tell the month and the year it was devel-
oped. A handy record your customers appreciate.

Both at no extra cost to you or your customers!

Both designed to build your photo-finishing profits!

You get both of these tremendous profit-boost-
ing features FREE when you’re a District Photo
Dealer. We’re the company that’s first with the
best new developments in photo-finishing —
Big Shot Borderless Photoprints, Bonus Photo,
Silk-Finish, and One-Day Service.

We believe in firsts, because they keep you first

in sales.
Call us. In D.C., 937-5300. In Baltimore, 792-7740.

OTHERS

Mr. George Karman, 85, died on April 12, 1976 in
Torance, California, following a heart attack. A graduate of
Concordia College and the University of Maryland School
of Pharmacy, Mr. Karman worked for pharmacies in
Anne

Baltimore, Ocean City, and Princess
Maryland, before his retirement in 1969.

County,

FOTO DATE: AUG., 1975

Whar NOPhay,
ee Post Card

wondigel Gobtih hve

Qa
a
<
oO
ws
w
“

$ $
2 ia 5
n way E
: ia ¢
2 +’ fe 5

Onn

E

POST-A-PHOTO pensonar
Pat pends

DISTRICT PHOTOING

10619 BALTIMORE AVENUE, BELTSVILLE, MARYLAND 20705

MAY 1976

THE MARYLAND PHARMACIST 29

Testing in Humans:

Who, Where & When.

the weight of ethical opinion:

Few would disagree that the effective-
ness and safety of any therapeutic agent
or device must be determined through
clinical research.

But now the practice of clinical re-
search is under appraisal by Congress, the
press and the general public. Who shall
administer it? On whom are the products
to be tested? Under what circumstances?
And how shall results be evaluated and
utilized?

The Pharmaceutical Manufacturers
Association represents firms that are sig-
nificantly engaged in the discovery and
development of new medicines, medical
devices and diagnostic products. Clinical
research is essential to their efforts. Con-
sequently, PMA formulated positions
which it submitted on July 11, 1975, to
the Subcommittee on Health of the Sen-
ate Labor and Public Welfare Committee,
as its official policy recommendations.
Here are the essentials of PMA’s current
thinking in this vital area,

1.PMA supports the mandate and
mission of the National Commission for
the Protection of Human Subjects of
Biomedical and Behavioral Research and
offers to establish a special committee
composed of experts of appropriate
disciplines familiar with the industry's
research methodology to volunteer its
service to the Commission.

2. PMA supports the formation of an
independent, expert, broadly based and
representative panel to assess the current
state of drug innovation and the impact
upon it of existing laws, regulations and
procedures.

3. When FDA proposes regulations,
it should prepare and publish in the Fed-
eral Register a detailed statement assess-
ing the impact of those regulations on
drug and device innovation.

4.PMA proposes that an appropri-
ately qualified medical organization be
encouraged to undertake a comprehen-
sive study of the optimum roles and
responsibilities of the sponsor and physt-
cian when company-sponsored clinical
research is performed by independent
clinical investigators.

§. PMA recognizes that the physician-
investigator has, and should have, the
ultimate responsibility for deciding the
substance and form of the informed con-
sent to be obtained. However, PMA
recommends that the sponsor of the ex-
periment aid the investigator in dis-
charging this important responsibility by
providing (1) a document detailing the
investigator's responsibilities under FDA
regulations with regard to patient consent,
and (2) a written description of the
relevant facts about the investigational.
item to be studied, in comprehensible
lay language.

©. In the case of children, the sponsor
must require that informed consent be
obtained from a legally appropriate rep-
resentative of the participant. Voluntary
consent of an older child, who may be
capable of understanding, in addition to
that of a parent, guardian or other legally
responsible person, is advisable. Safety of
the drug or device shall have been assessed
in adult populations prior to use in
children.

7.PMA endorses the general prin-
ciple thar, in the case of the mentally
infirm, consent should be sought from
both an understanding subject and from
a parent or guardian, or in their absence,
another legally responsible person.

8. Pharmaceutical manufacturers
sponsoring investigations in prisons must
take all reasonable care to assure that the
facilities and personnel used in the con-
duct of the investigations are suitable for
the protection of participants, and for the
avoidance of coercion, with a respect for
basic humanitarian principles.

9. Sponsors intending to conduct non-
therapeutic clinical trials through the
participation of employee volunteers
should expand the membership and scope
of its existing Medical Research Commit-
tee, or establish such an internal Medical
Research Committee, with responsibility
to approve the consent forms of all
volunteers, designs, protocols and the
scope of the trial: The Committee should
also bear responsibility to ensure full
compliance with all procedures intended
to protect employee volunteers’ rights.

10. Where the sponsor obtains medi-
cal information or data on individuals, it
shall be accorded the same confidential

status as provided in codes of ethics gov-
erning health care professionals.

U1.PMA and its member firms accept
responsibility to aid and encourage ap-
propriate follow-up of human subjects
who have received investigational prod-
ucts that cause latent toxicity in animals
or, during their use in clinical investiga-
tion, are found to cause unexpected and
serious adverse effects.

12. PMA supports the exploration
and development by its member compa-
nies of more systematic surveillance pro-
cedures for newly marketed products.

13. When a pharmaceutical manu-
facturer concludes, on the basis of early
clinical trials of a basic new agent, that a
new drug application is likely to be sub-
mitted, a proposed development plan
accompanied by a summary of existing
data, would be submitted to the FDA.
Following a review of this submission,
the FDA, and its Advisory Committee
where appropriate, would meet with the
sponsor to discuss the development plan.
No formal FDA approval should be re-
quired at this stage. Rather, the emphasis
should be on identification of potential
problems and questions for the sponsor's
further study and resolution as the pro-
gram develops. :

The PMA believes that health profes-
sionals as well as the public at large
should be made aware of these 13 points
in its Policy on Clinical Research. For
these recommendations envisage con-
structive, cooperative action by industry,
research institutions, the health profes-
sions and government to encourage crea-
tive and workable responses to issues
involved in the clinical investigation of
new products.

Pharmaceutical Manufacturers

Association

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THE
MARYLAND
2HARMACIST

Yfficial Journal of
[he Maryland
Pharmaceutical
Association

JUNE 1976

VOL 52
VO 6

Prescription Price Advertising
A Landmark Decision of the
U.S. Supreme Court

The Supreme Court Speaks —

A Perception of Pharmacy.
An Editorial

Complete Text of Decision
In This Issue

September 19-23 — NARD Convention, San Francisco

January 14-21 — MPhA Seminar Tour — Mexico City—Acapulco

DEAN SULLIVAN

k . & 3
GORDON KNIGHT

BILL HYSSONG

JOHN O'MALLEY

tg, ¢ pi

TOM DONOVAN

Mires,

BOB MU

WE'RE PUTTING
OUR BEST FACES FORWARD

The faces of SKGF Representatives who stand ready

to help you in any way with anything to do with SKGF.

If you have a question or a problem, just ask.
SY

Smith Kline & French Laboratories U/)

Division of SmithKline Corporetion

BOB GITTINGS ‘see :
MMEY TIM BRODERICK

The one the patient takes
is never tested.

Surprising, perhaps, butit makes sense
when you think about it.

Obviously, the actual dose of any pre-
scription drug the patient takes cannot be
tested because it would have to be broken
down for analysis—after which it could
never be used by a patient.

This means that you depend on the
manufacturer for assurance that the dose
the patient takes is identical to the ones
which have been tested.

At each step in the manufacture of a
Lilly drug, test after test confirms the in-
gredients, formulation, purity, and
accuracy—all the critical factors that as-
sure that every Lilly medicine is just what
the doctor ordered.

Thats particularly important, as you
know. The same drug made by different
companies can be chemically identical
yet may act differently in the human body
because of the many variables in the way
the drugs are manufactured.

And, of course, government standards
alone do not assure the efficacy and con-
sistency—the quality of each drug you
dispense.

As we at Eli Lilly and Company see it,
the ultimate responsibility for quality is
ours.

For four generations we've been mak-
ing medicinesas if people's lives depended
on them.

600090

Lilly

ELI LILLY AND COMPANY, INDIANAPOLIS, INDIANA 46206

editorial

THE SUPREME COURT SPEAKS —
A PERCEPTION OF PHARMACY

Pharmacists are justified in reacting in outrage to the majority
decision and opinions of the United States Supreme Court in
voiding all state prohibitions on prescription price advertising.
Of course, aside from indignation nothing else can be done,
unless perchance some new kind of case some years from now
will be heard by the court.

Because we cannot alter the decision, let us see what we can
learn from the several opinions — the majority view by Justice
Blackmun, the separately stated concurring opinions of Chief
Justice Burger and Justice Stewart, and the lone dissenting opin-
ion of Justice Rehnquist.

When you read and study the opinions, including footnotes,
published in full in this issue of The Maryland Pharmacist, one
sees that although the legalistic basis is the protection of the
First Amendment of the U.S. Constitution: freedom of speech,
the justices were swayed by socio-economic factors and by their
perceptions of the role of the pharmacist.

Justice Blackmun refers to suppression of price information
hitting the poor, sick and aged the hardest and that this group
tends to spend a disproportionate amount of their income on
prescription drugs. He asserts that ‘‘drug prices vary . . . strik-
ingly.”

The learned justices also seem to have swallowed the Federal
Trade Commission (FTC) staff’s flimsily based prediction that
outlawing advertising restrictions would save “millions of dol-
lars per year.”

The gratuitous remark of Chief Justice Burger in equating the
dispensing services of a pharmacist with the services of a clerk
selling lawbooks betrays an appalling ignorance for a member
of the highest court. If other cases are adjudicated with similar
levels of research and understanding, we fear for the validity of
court decisions in other specialized fields.

But the important point is that the Chief Justice seeks to
differentiate between the function of pharmacists who ‘‘dis-
pense standardized products” and the ‘‘traditional learned pro-
fessions of medicine and law.’’ He says “they render profes-
sional services of almost infinite variety and nature. . .”

Fortunately for the record, Justice Rehnquist, in his lone
dissent, disputes the Chief Justice’s differentiations between
the pharmacist and other professions. He also emphasizes the
“very real dangers that general advertising” might create.

Nevertheless, we must face the crux of the situation which
pharmacists have found themselves in since the great decline in
compounding set in. Pharmacists lost the mystique associated
with compounding. They isolated themselves behind counters
and insulated themselves from the people (patients) they
served. They became identified primarily with the packaging of
‘merchandise’ — a drug product.

4

Only pharmacists who established and maintained a per
sonalized relationship with their patients and demonstratec
professional services beyond simple dispensing have been able
to achieve recognition as health professionals.

Maintaining current knowledge and competency throug}
continuing education, counseling patients on the use of bot
prescribed and over-the-counter medication, properly using
patient medication profiles, achieving acceptance as qualifiec
consultants in drug therapy to prescribers, involvement ir
health and community organizations and participation in pro
fessional pharmaceutical societies — these are some of the
hallmarks of the professional person.

What then are the lessons of this landmark decision?

What finally counts is not what we think of ourselves and o
our contributions to the health and welfare of our communities

Fancy public relations campaigns cannot change what the
public sees and what the public experiences.

What ultimately counts is what the general society including
the Supreme Court justices perceives as the role of the pharma
cist.

If you are part of the ownership or management of any phar
macy — independent, chain or institutional — you set the
policies, the tone, the quality of your pharmacy and its services.
If you are a practicing pharmacist, your daily actions eithe:
confirm or refute the prevailing perception of the pharmacist as
one who “no more renders a true professional service than does
a clerk who sells lawbooks.”

— Nathan I. Gruz

Ealencex

September 9 (Thursday) — MSHP Meeting, Johns
Hopkins Hospital

September 19-23 — NARD Convention, San
Francisco

November 4 (Thursday) — MPhA Simon Solomon
Economics Seminar

1977,

January 14-21 — MPhA Seminar and Tour —
Acapulco and Mexico City

February 13 (Sunday) — BMPA Annual Banquet,
Bluecrest

March 5-13 — MPhA Trip to Vail, Colorado

a

THE MARYLAND PHARMACIS

THE MARYLAND PHARMACIST

650 WEST LOMBARD STREET
BALTIMORE MARYLAND 21201
TELEPHONE 301/727-0746

JUNE 1976 VOL. 52

CONTENTS

4 Editorial — The Supreme Court Speaks — A Perception of
Pharmacy

6 Prescription Price Advertising — Supreme Court Decision.
Syllabus
Virginia State Board of Pharmacy v. Virginia Citizens Consumer
Council

6 Majority Opinion — Mr. Justice Blackmun

20 Concurring Opinion — Mr. Chief Justice Burger
21. Concurring Opinion — Mr. Justice Stewart

24 Dissenting Opinion — Mr. Justice Rehnquist

31 Footnotes to Supreme Court Decision

ADVERTISERS

28 Abbott 27 Lederle Pharmaceuticals
18-19, 3 Eli Lilly & Co., Inc.
22-23 Burroughs Wellcome

36 Loewy Drug Company

13 Calvert Drug Company BoM aryianciNews

30 F.A. Davis Distributing Company
16 District Photo Service 7 Mayer & Steinberg, Inc.
9,10 Geigy Pharmaceuticals 35 Paramount Photo Service
15 The Henry B. Gilpin Company 2 Smith, Kline and French

Change of address may be made by sending old address (as it appears on your journal) and new address
with zip code number. Allow four weeks for changeover. APhA members — please include APhA number.

The Maryland Pharmacist is published monthly, except for January, February, and March, 1976, combined,
by the Maryland Pharmaceutical Association, 650 West Lombard Street, Baltimore, Maryland 21201. Sub-
scription price is $5.00 a year. Entered as second class matter December 10, 1925, at the Post Office at
Baltimore, Maryland, under the Act of March 8, 1879.

NATHAN I. GRUZ, Editor
Ross P. CAMPBELL, News Correspondent
HERMAN BLOOM, Photographer

OFFICERS & BOARD OF TRUSTEES
1976-77

Honorary President

MORRIS LINDENBAUM

President

MELVIN N. RUBIN—Baltimore

Vice President

JAMES W. TRUITT, JR.—Federalsburg
Treasurer

ANTHONY G. PADUSSIS—Timonium

Executive Director
NATHAN |. GRUZ—Baltimore

TRUSTEES

HENRY G. SEIDMAN, Chairman
Baltimore

LEONARD J. DeMINO (1978)
Wheaton

S. BEN FRIEDMAN (1979)
Potomac

RONALD A. LUBMAN (1979)
Baltimore

ROBERT J. MARTIN (1977)
LaVale

ROBERT E. SNYDER (1978)
Baltimore

STANLEY J. YAFFE (1977)
Odenton

EX-OFFICIO MEMBER
WILLIAM J. KINNARD, JR.—Baltimore

HOUSE OF DELEGATES

Speaker

VICTOR H. MORGENROTH, JR.—Ellicott
City

Vice Speaker

SAMUEL LICHTER—Randallstown

Secretary
NATHAN I. GRUZ—Baltimore

MARYLAND BOARD OF PHARMACY

Honorary President

FRANK BLOCK—Baltimore
President

1. EARL KERPELMAN—Salisbury
BERNARD B. LACHMAN—Pikesville
RALPH T. QUARLES, SR.—Baltimore
CHARLES H. TREGOE—Parkton

Secretar
ROBERT E. SNYDER—Baltimore

IUNE, 1976

Prescription Price Advertising — |
A Landmark Decision

Complete Text |

SUPREME COURT OF THE UNITED STATES

Syllabus

VIRGINIA STATE BOARD OF PHARMACY Et At.
v. VIRGINIA CITIZENS CONSUMER COUNCIL,
ING., ET AL.

APPEAL FROM THE UNITED STATES DISTRICT COURT FOR
THE EASTERN DISTRICT OF VIRGINIA

No. 74-895. Argued November 11, 1975—Decided May 24, 1976

Appellees, as consumers of prescription drugs, brought suit against
the Virginia State Board of Pharmacy and its individual members,
appellants herein, challenging the validity under the First and
Fourteenth Amendments of the Virginia statute declaring it un-
professional conduct for a licensed pharmacist to advertise the
prices of prescription drugs. A three-judge District Court de-
clared the statute void and enjoined appellants from enforcing it.
Held:

1. Any First Amendment protection enjoyed by advertisers
seeking to disseminate prescription drug price information is also
enjoyed, and thus may be asserted, by appellees as recipients of
such information. Pp. 8-9.

2. “Commercial speech” is not wholly outside the protection
of the First and Fourteenth Amendments, and the Virginia statute
is therefore invalid. Pp. 13-25.

(a) That the advertiser’s interest in a commercial advertise-
ment is purely economic does not disqualify him from protection
under the First and Fourteenth Amendments. Both the indi-
vidual consumer and society in general may have strong interests
in the free flow of commercial information. Pp. 14-17.

(b) The ban on advertising prescription drug prices cannot
be justified on the basis of the State’s interest in maintaining the
professionalism of its licensed pharmacists; the State is free to
require whatever professional standards it wishes of its pharma-
cists, and may subsidize them or protect them from competition
in other ways, but it may not do so by keeping the public in
ignorance of the lawful terms that competing pharmacists are
offering. Pp. 18-22.

(c) Whatever may be the bounds of time, place, and manner
restrictions on commercial speech, they are plainly exceeded by
the Virginia statute, which singles out speech of a particular con-
tent and seeks to prevent its dissemination completely. P. 23.

(d) No claim is made that the prohibited prescription drug
advertisements are false, misleading, or propose illegal trans-
actions, and a State may not suppress the dissemination of con-
cededly truthful information about entirely lawful activity, fearful
of that information’s effect upon its disseminators and its recipi-
ents. Pp. 23-25.

373 F. Supp. 683, affirmed.

BiackKMUN, J., delivered the opinion of the Court, in which
Burcer, C. J., and BRENNAN, STEWART, WHITE, MARSHALL, and
Powe, JJ., jomed. Burcer, C. J., and Stewart, J., filed con-
curring opinions. RErHNQuIsT, J., filed a dissenting opinion. STsE-
VENS, J., took no part in the consideration or decision of the case.

6

Mr. Justice BLACKMUN delivered the opinion of the
Court.

The plaintiff-appellees in this case attack, as violative
of the First-and Fourteenth Amendments,’ that portion
of § 54-524.35 of Va. Code Ann. (1974), which provides
that a pharmacist licensed in Virginia is guilty of unpro-
fessional conduct if he “(3) publishes, advertises or pro-
motes, directly or indirectly, in any manner whatsoever,
any amount, price, fee, premium, discount, rebate or
credit terms ... for any drugs which may be dispensed
only by prescription.” * The three-judge District Court
declared the quoted portion of the statute “void and of no
effect,’ Juris. Statement App. 1, and enjoined the
defendant-appellants, the Virginia State Board of Phar-
macy and the individual members of that Board, from
enforcing it. 373 F. Supp. 683 (ED Va. 1974). We
noted probable jurisdiction of the appeal. 420 U.S. 971
(1975).

The ‘practice of pharmacy’ is statutorily declared to be
‘a professional practice affecting the public health,
safety and welfare’, and to be ‘subject to regulation
and control in the public interest’. . . Indeed, the
practice is subject to extensive regulation aimed at |
preserving high professional standards.

ee C—i=*#”#eN. . ~~ _____ ..__—____________.___ "Gn

' |

Since the challenged restraint is one that peculiarly
concerns the licensed pharmacist in Virginia, we begin
with a description of that profession as it exists under |
Virginia law.

The “practice of pharmacy” is statutorily declared to
be ‘‘a professional practice affecting the public health,
safety and welfare,” and to be “subject to regulation and
control in the public interest.” Va. Code Ann. § 54
524.2 (a) (1974).° Indeed, the practice is subject to ex-
tensive regulation aimed at preserving high professional
standards. The regulatory body is the appellant Vir-
ginia State Board of Pharmacy. The Board is broadly
charged by statute with various responsibilities, includ-
ing the “[m]aintenance of the quality, quantity, in-
tegrity, safety and efficacy of drugs or devices distributed,
dispensed or administered.” § 54-524.16 (a). It also
is to concern itself with “{m]aintaining the integrity of,

(Continued on Page 8

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and public confidence in, the profession and improving
the delivery of quality pharmaceutical services to the

citizens of Virginia.” § 54-524.16(d). The Board is
empowered to “make such bylaws, rules and regula-

tions .. . as may be necessary for the lawful exercise of
its powers.” § 54-524.17.

The appellants contend that the advertisement of
prescription drug prices is outside the protection of
the First Amendment because it is ‘commercial
speech.’

el

The Board is also the licensing authority. It may
issue a license, necessary for the practice of pharmacy in
the State, only upon evidence that the applicant is “of
good moral character,’ is a graduate in pharmacy of a
school approved by the Board, and has had “a suitable
period of experience [not to exceed 12 months] accept-
able to the Board.” §54-524.21. The applicant
must pass the examination prescribed by the Board.
Ibid. One approved school is the School of Pharmacy
of the Medical College of Virginia, where the curriculum
is for three years following two years of college. Pre-
scribed prepharmacy courses, such as biology and chem-
istry, are to be taken in college, and study requirements
at the school itself include courses in organic chemistry,
biochemistry, comparative anatomy, physiology, and
pharmacology. Students are also trained in the ethics of
the profession, and there is some clinical experience in
the school’s hospital pharmacies and in the medical cen-
ter operated by the Medical College. This is “a rigid,
demanding curriculum in terms of what the pharmacy
student is expected to know about drugs.” *

Once licensed, a pharmacist is subject to a civil mone-
tary penalty, or to revocation or suspension of his license,
if the Board finds that he “is not of good character,” or
has violated any of a number of stated professional stand-
ards (among them that he not be “negligent in the prac-
tice of pharmacy” or have engaged in “fraud or deceit
upon the consumer .. . in connection with the practice
of pharmacy’), or is guilty of “unprofessional conduct.”
Va. Code Ann. § 54-524.22:1. ‘“Unprofessional conduct”
is specifically defined in § 54-524.35, n. 2, supra, the third
numbered phrase of which relates to advertising of the
price for any prescription drug, and is the subject of this
litigation.

Inasmuch as only a licensed pharmacist may dispense
prescription drugs in Virginia, § 54-524.48,° advertising
or other affirmative dissemination of prescription drug
price information is effectively forbidden in the State.
Some pharmacies refuse even to quote prescription drug
prices over the telephone. The Board’s position, how-
ever, is that this would not constitute an unprofessional
publication.® It is clear, nonetheless, that all advertis-

8

ing of such prices, in the normal sense, is forbidden. The
prohibition does not extend to nonprescription drugs,
but neither is it confined to prescriptions that the phar-
macist compounds himself. Indeed, about 95% of all
prescriptions now are filled with dosage forms prepared
by the pharmaceutical manufacturer.’

II

This is not the first challenge to the constitutionality of
§ 54-524.35 and what is now its third numbered phrase. |
Shortly after the phrase was added to the statute in 1968" |
a suit seeking to enjoin its operation was instituted by
a drug retailing company and one of its pharmacists,
Although the First Amendment was invoked, the chal-
lenge appears to have been based primarily on the Due |
Process and Equal Protection Clauses of the Fourteenth |
Amendment. In any event, the prohibition on drug
price advertising was upheld. Patterson Drug Co. vV.
Kingery, 305 F. Supp. 821 (WD Va. 1969). The three-
judge court did find that the dispensation of prescription
drugs “affects the public health, safety and welfare.”
Id., at 824-825. No appeal was taken.’

[In 1969 a] three judge court did find that the dispen-
sation of prescription drugs ‘affects the public health,
safety and welfare.’

The present, and second, attack on the statute is one
made not by one directly subject to its prohibition, that
is, a pharmacist, but by prescription drug consumers who _
claim that they would greatly benefit if the prohibition —
were lifted and advertising freely allowed. The plaintiffs —
are an individual Virginia resident who suffers from |
diseases that require her to take prescription drugs on a_
daily basis,? and two nonprofit organizations.” Their |
claim is that the First Amendment entitles the user of
prescription drugs to receive information, that pharma-
cists wish to communicate to them through advertising |
and other promotional means, concerning the prices of |
such drugs. .

Certainly that information may be of value. Drug.
prices in Virginia, for both prescription and nonprescrip-
tion items, strikingly vary from outlet to outlet even
within the same locality. It is stipulated, for example, |
that in Richmond “the cost of 40 Achromycin tablets
ranges from $2.59 to $6.00, a difference of 140% [sic],”
and that in the Newport News-Hampton area the cost of
tetracycline ranges from $1.20 to $9.00, a difference of
650%." .

The District Court seized on the identity of the plain--
tiff-appellees as consumers as a feature distinguishing the
present case from Patterson Drug Co. v. Kingery, supra.
Because the unsuccessful plaintiffs in that earlier case
were pharmacists, the court said, “theirs was a prima

(Continued on Page 11,

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Prescribing Information

Description Brethine, brand of terbutaline sul-
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Brethine, brand of terbutaline sulfate, is a water
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taining Brethine, brand of terbutaline sulfate,

should be stored at controlled room temperature.

Each scored, white tablet contains 5 mg. (equiv-
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of terbutaline sulfate.

Actions Brethine, brand of terbutaline sulfate, is
a B-adrenergic receptor agonist which has been
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on £, adrenergic receptors such as those located
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or longer. Significant bronchodilator action, as
measured by various pulmonary function deter-
minations (airway resistance, FEFo5.759,, Or
PEFR), has been demonstrated in some studies
for periods up to eight hours.

Clinical studies were conducted in which the
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drine over periods up to three months. Both
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ment in pulmonary function throughout this
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Indications Brethine, brand of terbutaline sulfate,
is indicated as a bronchodilator for bronchial
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emphysema.

Contraindications Brethine, brand of terbuta-
line sulfate, is contraindicated when there Is
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amines.

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bearing potential requires that the expected thera-
peutic benefit of the drug be weighed against

its possible hazards to the mother or child.

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line sulfate, tablets are not presently recom-
mended for children below the age of 12 years
due to insufficient clinical data in this pediatric
group.

Precautions Brethine, brand of terbutaline sul-
fate, should be used with caution in patients
with diabetes, hypertension, and hyperthyroidism.

As with other sympathomimetic bronchodilator
agents, Brethine, brand of terbutaline sulfate,
should be administered cautiously to cardiac
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arrhythmias

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be deleterious to the patient. However, this does
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sulfate, therapy.

Adverse Reactions Commonly observed side
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ing, and sweating. These reactions are generally
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treatment. The frequency of these side effects
appears to diminish with continued therapy. In
general, all the side effects observed are charac-
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thomimetic amines.

Dosage and Administration The usual oral dose
of Brethine, brand of terbutaline sulfate, for
adults is 5 mg. administered at approximately
six-hour intervals, three times daily, during the
hours the patient is usually awake. If side effects
are particularly disturbing, the dose may be re-
duced to 2.5 mg., three times daily, and still pro-
vide a Clinically significant improvement in pul-
monary function. A dose of 2.5 mg., three times
daily, also is recommended for children in the 12-
to 15-year group. Brethine, brand of terbutaline
sulfate, is not recommended at present for use
in children below the age of 12 years. In adults, a
total dose of 15 mg. should not be exceeded ina
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BR 11331

facie commercial approach,” 373 F. Supp., at 686. The
present plaintiffs, on the other hand, were asserting an
interest in their own health that was “fundamentally
deeper than a trade consideration.” Jbid. In the Dis-
trict Court’s view, the expression in Valentine v. Chres-
tensen, 316 U. S. 52, 54-55 (1942), to the effect that
“purely commercial advertising” is not protected had
been tempered, by later decisions of this Court, to the
point that First Amendment interests in the free flow
of price information could be found to outweigh the
countervailing interests of the State. The strength of
the interest in the free flow of drug price information
was borne out, the court felt, by the fact that three
States by court decision had struck down their prohibi-
tions on drug price advertising. Florida Board of Phar-
macy v. Webb’s City, Inc., 219 So. 2d 681 (Fla. 1969) ;
Maryland Board of Pharmacy v. Sav-A-Lot, Inc., 270
Md. 103; 311 A. 2d 242 (1973); Pennsylvania State
Board of Pharmacy v. Pastor, 441 Pa. 186, 272 A. 2d 487
(1971).** The District Court recognized that this Court
had upheld—against federal constitutional challenges
other than on First Amendment grounds—state restric-
tions on the advertisement of prices for optometrists’
services, Head v. New Mezico Board, 374 U. S. 424
(1963), for eyeglass frames, Williamson v. [ge Optical
Co., 348 U.S. 483 (1955), and for dentists’ services, Sem-
ler v. Dental Examiners, 294 U. S. 608 (1935).%% The
same dangers of abuse and deception were not thought to
be present, however, when the advertised commodity
was prescribed by a physician for his individual patient
and was dispensed by a licensed pharmacist. The Board
failed to justify the statute adequately, and it had to fall.
373 F. Supp., at 686-687.

Because the unsuccessful plaintiffs in that earlier case
were pharmacists, the court said ‘theirs was a prima
facie commercial approach’ .. . The present plain-
tiffs, on the other hand, were asserting an interest in
their own health that was ‘fundamentally deeper than
a trade consideration.’

Ill

The question first arises whether, even assuming that
First Amendment protection attaches to the flow of drug
price information, it is a protection enjoyed by the ap-
pellees as recipients of the information, and not solely,
if at all, by the advertisers themselves who seek to dis-
seminate that information.

Freedom of speech presupposes a willing speaker. But
where a speaker exists, as is the case here,‘ the protec-
tion afforded is to the communication, to its source and
to its recipients both. This is clear from the decided

IUNE, 1976

cases. In Lamont v. Postmaster General, 381 U.S. 301
(1965), the Court upheld the First Amendment rights of
citizens to receive political publications sent from abroad.
More recently, in Kleindienst v. Mandel, 408 U. S. 753,
762-763 (1972), we acknowledged that this Court has
referred to a First Amendment right to “receive informa-
tion and ideas,” and that freedom of speech “ ‘necessarily
protects the right to receive.” And in Procunier v.
Martinez, 416 U. S. 396, 408-409 (1974), where censor-
ship of prison inmates’ mail was under examination, we
thought it unnecessary to assess the First Amendment
rights of the inmates themselves, for it was reasoned that
such censorship equally infringed the rights of noninmates
to whom the correspondence was addressed. There are
numerous other expressions to the same effect in the
Court’s decisions. See, e. g., Red Lion Broadcasting Co.
v. FCC, 395 U. S. 367, 390 (1969); Stanley v. Georgia,
394 U. 8. 557, 564 (1969); Griswold v. Connecticut, 381
U.S. 479, 482 (1965); Marsh v. Alabama, 326 U. S. 501,
505 (1946) ; Thomas v. Collins, 323 U.S. 516, 534 (1945) ;
Martin v. Struthers, 319 U.S. 141, 143 (1943). If there
is a right to advertise, there is a reciprocal right to re-
ceive the advertising, and it may be asserted by these
appellees.*®

The strength of the interest in the free flow of drug
price information was borne out, the court felt, by the
fact that three States by court decision had struck
down their prohibitions on drug price advertising.

IV

The appellants contend that the advertisement of pre-
scription drug prices is outside the protection of the First
Amendment because it is “commercial speech.” There
can be no question that in past decisions the Court has
given some indication that commercial speech is unpro-
tected. In Valentine v. Chrestensen, supra, the Court
upheld a New York statute that prohibited the distribu-
tion of any “handbill, circular .. . or other advertising
matter whatsoever in or upon any street.” The Court
concluded that, although the First Amendment would
forbid the banning of all communication by hand-
bill in the public thoroughfares, it imposed “no such
restraint on government as respects purely commercial
advertising.” 316 U. S., at 54. Further support for a
“commercial speech” exception to the First Amendment
may perhaps be found in Breard v. Alexandria, 341 U.S.
622 (1951), where the Court upheld a conviction for
violation of an ordinance prohibiting door-to-door solici-
tation of magazine subscriptions. The Court reasoned:
“The selling ... brings into the transaction a commercial

17

feature,” and it distinguished Martin v. Struthers, supra,
where it had reversed a conviction for door-to-door dis-
tribution of leaflets publicizing a religious mecting, as a
case involving “no element of the commercial.” 341
U. S.. at 642-643. Moreover, the Court several times
has stressed that communications to which First Amend-
ment protection was given were not “purely commercial.”
New York Times Co. v. Sullivan, 376 U. S. 254, 266
(1964); Thomas vy. Collins, 323 U. S., at 533; Murdock
v. Pennsylvania, 319 U. S. 105, 111 (1943); Jamison v.
Texas, 318 U.S. 413, 417 (1943).

Sn ER EP NS SS

The ‘idea’ the pharmacist wishes to communicate is
simply this: ‘I will sell you the X prescription at the Y
price.’ Our question, then, is whether this communi-
cation is wholly outside the protection of the First
Amendment.

Since the decision in Breard, however, the Court has
never denied protection on the ground that the speech
in issue was “commercial speech.” That simplistic ap-
proach, which by then had come under criticism or was
regarded as of doubtful validity by members of the
Court,’° was avoided in Pittsburgh Press Co. v. Pitts-
burgh Comm'n on Human Relations, 413 U. 8. 376
(1973). There the Court upheld an ordinance prohibit-
ing newspapers from. listing employment advertise-
ments in columns according to whether male or fe-
male employees were sought to be hired. The Court,
to be sure, characterized the advertisements as “classic
examples of commercial speech,” zd., at 385, and a news-
paper’s printing of the advertisements as of the same
character. The Court, however, upheld the ordinance
on the ground that the restriction it imposed was per-
missible because the discriminatory hirings proposed by
the advertisements, and by their newspaper layout, were
themselves illegal.

Last Term, in Bigelow v. Virginia, 421 U. S. 809
(1975), the notion of unprotected “commercial speech”’
all but passed from the scene. We reversed a conviction
for violation of a Virginia statute that made the circula-
tion of any publication to encourage or promote the
processing of an abortion in Virginia a misdemeanor.
The defendant had published in his newspaper the avail-
ability of abortions in New York. The advertisement in
question, in addition to announcing that abortions were
legal in New York, offered the services of a referral
agency in that State. We rejected the contention that
the publication was unprotected because it was commer-
cial. Chrestensen’s continued validity was questioned,
and its holding was described as “distinctly a limited
one” that merely upheld “a reasonable regulation of the
manner in which commercial advertising could be dis-
tributed.” 421 U.S., at 819. We concluded that “the

12

Virginia courts erred in their assumptions that advertis-
ing, as such, was entitled to no First Amendment pro-
tection,’ and we observed that the “relationship of
speech to the marketplace of products or of services does
not make it valueless in the marketplace of ideas.” /d.,
at 825-826.

Some fragment of hope for the continuing validity of
a “commercial speech” exception arguably inight have
persisted because of the subject matter of the advertise-
ment in Bigelow. We noted that in announcing the
availability of legal abortions in New York, the adver-
tisement “did more than simply propose a commercial
transaction. It contained factual material of clear ‘pub-

ee

lic interest.’”” Jd., at 822. And, of course, the adver- |
tisement related to activity with which, at least in some

respects, the State could not interfere. See Roe v. Wade,

410 U. S. 113 (1973); Doe v. Bolton, 410 U. S. 179

(1973). Indeed, we observed: “We need not decide in
this case the precise extent to which the First Amend-

ment permits regulation of advertising that is related to |

activities the State may legitimately regulate or even
prohibit. “3 id5- at) 825.
Here, in contrast, the question whether there is a

First Amendment exception for “commercial speech” is.

squarely before us. Our pharmacist does not wish to
editorialize on any subject, cultural, philosophical, or
political. He does not wish to report any particularly
newsworthy fact, or to make generalized observations
even about commercial matters. The “idea” he wishes
to communicate is simply this: “I will sell you the X
prescription drug at the Y price.” Our question, then,
is whether this communication is wholly outside the
protection of the First Amendment.

V

We begin with several propositions that already are
settled or beyond serious dispute. It is clear, for ex-
ample, that speech does not lose its First Amendment
protection because money is spent to project it, as in a
paid advertisement of one form or another. Buckley y.
Valeo, —— U. 8. —— (1976); Pittsburgh Press Co. v.
Pittsburgh Comm’n on Human Relations, 413 U. S., at
384; New York Times Co. v. Sullivan, 376 U.S., at 266.
Speech likewise is protected even though it is carried in
a form that is “sold” for profit, Smith v. California, 361
U. S. 141, 150 (1959) (books); Joseph Burstyn, Inc. Vv.
Wilson, 343 U. 8. 495, 501 (1952) (motion pictures);
Murdock vy. Pennsylvania, 319 U. S., at 111 (religious
literature), and even though it may involve a solicitation
to purchase or otherwise pay or contribute money. New
York Times Co. v. Sullivan, supra; NAACP vy. Button,
371 U.S. 415, 429 (1963); Jamison v. Texas, 318 U.S.
at 417; Cantwell v. Connecticut, 310 U. S. 296, 306-307
(1940).

If there is a kind of commercial speech that lacks all
First Amendment protection, therefore, it must be dis-

THE MARYLAND PHARMACIS,

| tinguished by its content. Yet the speech whose con-
tent deprives it of protection cannot simply be speech
on a commercial subject. No one would contend that
our pharmacist may be prevented from being heard on
the subject of whether, in general, pharmaceutical prices
should be regulated, or their advertisement forbidden.
Nor can it be dispositive that a commercial advertise-
ment is uneditorial, and merely reports a fact. Purely
factual matter of public interest may claim protection.

SS

Those whom the suppression of prescription drug
price information hits the hardest are the poor, the
sick, and particularly the aged. A disproportionate
amount of theirincome tends to be spent on prescrip-
tion drugs; yet they are the least able to learn, by
shopping from pharmacist to pharmacist, where their
scarce dollars are best spent. When drug prices vary as
strikingly as they do, information as to who is charg-
ing what becomes more than a convenience .. . It
could mean the alleviation of physical pain or the
enjoyment of basic necessities.

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ASTRO = CO-OP AD PROGRAM
CAL-SAV = POINT OF PURCHASE PROGRAM

D.P.P. = DIRECT PURCHASE-PROGRAM
W.S.P. = WEEKLY SPECIALS PROGRAM

C.P.P. = CONTROLLED PERCENTAGE PROGRAM
PHONE: (301) 467-2780
THE CALVERT DRUG COMPANY

901 CURTAIN AVENUE
BALTIMORE, MARYLAND 21218

°°, %. o%e aTectcctectectectee”
+ 9,8 #49 0,9 010 00 O00 oO 0 + 9 ooo,

Bigelow vy, Virginia, 412 U. S., at 822: Thornhill v. Ala-
bama, 310 U.S. 88, 102 (1940).

Our question is whether speech which does “no more
than propose a commercial transaction,’ Pittsburgh
Press Co. v. Pittsburgh Comm’n on Human Relations.
413 U.S., at 385, is so removed from any “exposition of
ideas,” Chaplinsky v. New Hampshire, 315 U.S. 568, 572
(1942), and from “ ‘truth, science, morality, and arts in
general, in its diffusion of liberal sentiments on the ad-
ministration of Government.’” Roth y. United States,
354 U. S. 476, 484 (1957), that it lacks all protection.
Our answer is that it is not.

Focusing first on the individual parties to the transac-
tion that is proposed in the commercial advertisement, we
may assume that the advertiser’s interest is a purely eco-
nomic one. That hardly disqualifies him for protection
under the First Amendment. The interests of the con-
testants in a labor dispute are primarily economic, but it
has long been settled that both the employee and the
employer are protected by the First Amendment when
they express themselves on the merits of the dispute in
order to influence its outcome. See, e. g., NLRB v. Gis-
sel Packing Co., 395 U. S. 575, 617-618 (1969): NLRB v.
Virginia Electric & Power Co., 314 U.S. 469, 477 (1941);
AFL v. Swing, 312 U.S. 321, 325-326 (1941); Thornhill
v. Alabama, 310 U.S., at 102. We know of no require-

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ment that, in order to avail themselves of First Amend-
ment protection, the parties to a labor dispute need
address themselves to the merits of unionism in general
or to any subject beyond their immediate dispute.” It
was observed in Thornhill that “the practices in a single
factory may have economic repercussions upon @ whole
region and affect widespread systems of marketing.”
Id., at 103. Since the fate of such a “single factory”
could as well turn on its ability to advertise its product
as on the resolution of its labor difficulties, we see no
satisfactory distinction between the two kinds of speech.

As to the particular consumer’s interest in the free
flow of commercial information, that interest may be as
keen, if not keener by far, than his interest in the day’s
most urgent political debate. Appellees’ case in this
respect is a convincing one. Those whom the suppres-
sion of prescription drug price information hits the hard-
est are the poor, the sick, and particularly the aged. A
disproportionate amount of their income tends to be
spent on prescription drugs; yet they are the least able to
learn, by shopping from pharmacist to pharmacist, where
their scarce dollars are best spent.’* When drug prices
vary as strikingly as they do, information as to who is
charging what becomes more than a convenience. It
could mean the alleviation of physical pain or the enjoy-
ment of basic necessities.

ES ER RT RRS ES TI A EE AE PC LET EE SN SE LS ELSIE SE ELD,

We have returned to the original constitutional prop-
osition that courts do not substitute their social and
economic beliefs for the judgment of legislative
bodies who are elected to pass law.

— tr aman ineineienn ERR

Generalizing, society also may have a strong interest
in the free flow of commercial information. Even an
individual advertisement, though entirely “commercial,”
may be of general public interest. The facts of decided
cases furnish illustrations: advertisements stating that
referral services for legal abortions are available, Bigelow
v. Virginia, supra; that a manufacturer of artificial furs
promotes his product as an alternative to the extinction
by his competitors of fur-bearing mammals, see Fur In-
formation & Fashion Council, Inc. v. E. F. Timme &
Son, 364 F. Supp. 16 (SDNY 1973); and that a domestic
producer advertises his product as an alternative to im-
ports that tend to deprive American residents of their
jobs, ef. Chicago Joint Board v. Chicago Tribune Co.,
435 F. 2d 470 (CA7 1970), cert. denied, 402 U. S. 973
(1971). Obviously, not all commercial messages con-
tain the same or even a very great public interest ele-
ment. There are few to which such an element, however,
could not be added. Our pharmacist, for example, could
cast himself as a commentator on store-to-store dispari-
ties in drug prices, giving his own and those of a com-
petitor as proof. We see little point in requiring him
to do so, and little difference if he does not.

14

Moreover. there is another consideration that suggests
that no line between publicly “interesting” or “impor-
tant” commercial advertising and the opposite kind could
ever be drawn. Advertising, however tasteless and ex-
cessive it sometimes may seem, is nonetheless dissemina-
tion of information as to who is producing and selling
what product, for what reason, and at what price. So

LL

The same dangers of abuse and deception were not
thought to be present, however, when the advertised
commodity was prescribed by a physician for his indi-
vidual patient and was dispensed by a licensed phar-
macist. The Board failed to justify the statute
adequately, and it had to fall.

long as we preserve a predominantly free enterprise econ-
omy, the allocation of our resources in large measure
will be made through numerous private economic de-
cisions. It is a matter of public interest that those
decisions, in the aggregate, be intelligent and well in-
formed. To this end, the free flow of commercial infor-
mation is indispensable. See Dun & Bradstreet, Inc. v.
Grove, 404 U. S. 898, 904-906 (1971) (Douglas, J., dis-
senting from denial of certiorari). See also FTC vy.
Proctor & Gamble Co., 386 U. S. 568, 603-604 (1967)
(Harlan, J., concurring). And if it is indispensable to
the proper allocation of resources in a free enterprise
system, it is also indispensable to the formation of intel-
ligent opinions as to how that system ought to be regu-
lated or altered. Therefore, even if the First Amend-
ment were thought to be primarily an instrument to
enlighten public decisionmaking in a democracy,’” we
could not say that the free flow of information does not
serve that goal.*°

—

Arrayed against these substantial individual and
societal interests are anumber of justifications for the
advertising ban. These have to do principally with
maintaining a high degree of professionalism on the
part of licensed pharmacists.

Arrayed against these substantial individual and socie-
tal interests are a number of justifications for the adver-
tising ban. These have to do principally with maintain-
ing a high degree of professionalism on the part of
licensed pharmacists.”’ Indisputably, the State has a
strong interest in maintaining that professionalism. It
is exercised in a number of ways for the consumer’s

(Continued on Page 16)

THE MARYLAND PHARMACIST

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benefit. There is the clinical skill involved in the com-
pounding of drugs, although, as has been noted, these
now make up only a small percentage of the prescrip-
tions filled. Yet, even with respect to manufacturer-
prepared compounds, there is room for the pharmacist
to serve his customer well or badly. Drugs kept too long
on the shelf may lose their efficacy or become adulter-
ated. They can be packaged for the user in such a way
that the same results occur. The expertise of the phar-
macist may supplement that of the prescribing physician,
if the latter has not specified the amount to be dispensed
or the directions that are to appear on the label. The
pharmacist, a specialist in the potencies and dangers of
drugs, may even be consulted by the physician as to
what to prescribe. He may know of a particular antago-
nism between the prescribed drug and another that the
customer is or might be taking, or with an allergy the
customer may suffer. The pharmacist himself may have
supplied the other drug or treated the allergy. Some
pharmacists, concededly not a large number, “monitor”
the health problems and drug consumptions of customers
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The expertise of the pharmacist may supplement that
of the prescribing physician. . . . The pharmacist, a
specialist in the potencies and dangers of drugs, may
even be consulted by the physician .

Price advertising, it is argued, will place in jeopardy
the pharmacist’s expertise and, with it, the customer’s
health. It is claimed that the aggressive price competi-
tion that will result from unlimited advertising will make
it impossible for the pharmacist to supply professional
services in the compounding, handling, and dispensing
of prescription drugs. Such services are time-consuming
and expensive; if competitors who economize by elimi-
nating them are permitted to advertise their resulting
lower prices, the more painstaking and conscientious
pharmacist will be forced either to follow suit or to go
out of business. It is also claimed that prices might not
necessarily fall as a result of advertising. If one phar-
macist advertises, others must, and the resulting expense
will inflate the cost of drugs. It is further claimed that
advertising will lead people to shop for their prescription
drugs among the various pharmacists who offer the low-

DISTRICT PHOTOINC

10619 BALTIMORE AVENUE, BELTSVILLE, MARYLAND 20705

16

THE MARYLAND PHARMACIST

est prices, and the loss of stable pharmacist-customer
relationships will make individual attention—and cer-
tainly the practice of monitoring—impossible. Finally,
it is argued that damage will be done to the professional
image of the pharmacist. This image, that of a skilled
and specialized craftsman, attracts talent to the profes-
sion and reinforces the better habits of those who are in
it. Price advertising, it is said, will reduce the pharma-
cist’s status to that of a mere retailer.**

Price advertising, it is said, will reduce the pharma-
cist’s status to that of a mere retailer.

The strength of these proffered justifications is greatly
undermined by the fact that high professional standards,
to a substantial extent, are guaranteed by the close regu-
lation to which pharmacists in Virginia are subject.
And this case concerns the retail sale by the pharmacist
more tnan it does his professional standards. Surely,
any pharmacist guilty of professional dereliction that
actually endangers his customer will promptly lose his
license. At the same time, we cannot discount the
Board’s justifications entirely. The Court regarded jus-
tifications of this type sufficient to sustain the advertising
bans challenged on due process and equal protection
grounds in Head v. New Mexico Board, supra; Williams
v. Lee Optical Co., supra; and Semler v. Dental Exam-
mers, supra.

The advertising ban does not directly affect profes-
sional standards one way or the other.

The challenge now made, however, is based on the
First Amendment. This casts the Board’s justifications
in a different light, for on close inspection it is seen that
the State’s protectiveness of its citizens rests in large
measure on the advantages of their being kept in igno-
rance. The advertising ban does not directly affect pro-
fessional standards one way or the other. It affects
them only through the reactions it is assumed people will
have to the free flow of drug price information. There
is no claim that the advertising ban in any way prevents
the cutting of corners by the pharmacist who is so in-
clined. That pharmacist is likely to cut corners in any
event. The only effect the advertising ban has on him
is to insulate him from price competition and to open
the way for him to make a substantial, and perhaps even
excessive, profit in addition to providing an inferior
service. The more painstaking pharmacist is also pro-
tected but, again, it is a protection based in large part on
public ignorance.

JUNE, 1976

The only effect the advertising ban has on him (the
pharmacist) is to insulate him from price competition
and to open the way for him to make substantial, and
perhaps even excessive, profit in addition to provid-
ing inferior service.

It appears to be feared that if the pharmacist who
wishes to provide low cost, and assertedly low quality,
services is permitted to advertise, he will be taken up on
his offer by too many unwitting customers. They will
choose the low-cost, low-quality service and drive ‘the
“professional” pharmacist out of business. They will re-
spond only to costly and excessive advertising, and end
up paying the price. They will go from one pharmacist
to another, following the discount, and destroy the phar-
macist-customer relationship. They will lose respect for
the profession because it advertises. All this is not in
their best interests, and all this can be avoided if they
are not permitted to know who is charging what.

There is, of course, an alternative to this highly pa-
ternalistic approach. That alternative is to assume that
this information is not in itself harmful, that people will
perceive their own best interests if only they are well
enough informed, and that the best means to that end is
to open the channels of communication rather than to
close them. If they are truly open, nothing prevents
the “professional” pharmacist from marketing his own
assertedly superior product, and contrasting it with that
of the low-cost, high-volume prescription drug retailer.
But the choice among these alternative approaches is not
ours to make or the Virginia General Assembly’s. It is
precisely this kind of choice, between the dangers of sup-
pressing information, and the dangers of its misuse if it
is freely available, that the First Amendment makes for
us. Virginia is free to require whatever professional
standards it wishes of its pharmacists; it may subsidize
them or protect them from competition in other ways.

Virginia is free to require whatever professional stan-
dards it wishes of its pharmacists; it may subsidize
them or protect them in other ways.

Cf. Parker v. Brown, 317 U. 8. 341 (1948). But it may
not do so by keeping the public in ignorance of the en-
tirely lawful terms that competing pharmacists are offer-
ing. In this sense, the justifications Virginia has offered
for suppressing the flow of prescription drug price infor-
mation, far from persuading us that the flow is not pro-
tected by the First Amendment, have re-enforced our view

that it is. We so hold.
(Continued on Page 20)

17

ity

Septra DS. The same reliable formulation

but doubled in tablet strength, lower in cost.

For patients with recurrent
urinary tract infections

Septr a DS: the same Septra

efficacy in recurrent cystitis,
pyelitis, and pyelonephritis due to
susceptible organisms

Septra DS: the same Septra
spectrum —E coli, Klebsiella-
Enterobacter, P mirabilis, P vulgaris,
P morganii

Septra DS: the same b.i.d.

dosage schedule, but one tablet
instead of two

Indications: Chronic urinary tract infections evidenced by persistent
bacteriuria (symptomatic or asymptomatic), frequently recurrent infec-
tions (relapse or reinfection), or infections associated with urinary tract
complications, suchas obstruction. Primarily for cystitis, pyelonephritis or
pyelitis due to susceptible strains of FE coli, Klebsiella-Enterobacter,
Proteus mirabilis, Proteus vulgaris and Proteus morganii.

NOTE: The increasing frequency of resistant organisms limits the useful-
ness of antibacterials, especially in these urinary tract infections.

The recommended quantitative disc susceptibility method (Federal Regis-
ter 37; 20627-20529, 1972) may be used to estimate bacterial suscepti-
bility to Septra. A laboratory report of ‘Susceptible to trimetho-
prim-sulfamethoxazole” indicates an infection likely to respond to Septra
therapy." Intermediate susceptibility” also indicates that response is likely
and “Resistant” that response is unlikely.

Contraindications: Hypersensitivity to trimethoprim or sulfonamides;
pregnancy; nursing mothers.

Warnings: Deaths from hypersensitivity reactions, agranulocytosis,
aplastic anemia and other blood dyscrasias have been associated with
sulfonamides. Experience with trimethoprim is much more limited but
occasional interference with hematopoiesis has been reported as well as
an increased incidence of thrombopenia with purpura in elderly patients on
certain diuretics, primarily thiazides. Sore throat, fever, pallor, purpura or

jaundice may be early signs of serious blood disorders. Frequent CBC’s are
recommended; therapy should be discontinued if a significantly reduced
count of any formed blood element is noted. At present, data are insufficient
to recommend use in infants and children under 12.

Precautions: Use with caution in patients with impaired renal or hepatic

function, possible folate deficiency, severe allergy or bronchial asthma. In

glucose-6-phosphate dehydrogenase deficient individuals, hemolysis may
occur (frequently dose-related). During therapy, maintain adequate fluid
intake and perform frequent urinalyses, with careful microscopic examina-

at and renal function tests, particularly where there is impaired renal
unction.

Adverse Reactions: All major reactions to sulfonamides and trimethoprim
are included, even if not reported with Septra. Blood dyscrasias: Agranulo-
cytosis, aplastic anemia, megaloblastic anemia, thrombopenia, leuko-
penia, hemolytic anemia, purpura, hypoprothrombinemia and
methemoglobinemia. A//ergic reactions: Erythema multiforme, Stevens-
Johnson syndrome, generalized skin eruptions, epidermal necrolysis,
urticaria, serum sickness, pruritus, exfoliative dermatitis, anaphylactoid
reactions, periorbital edema, conjunctival and scleral injection, photosen-
sitization, arthralgia and allergic myocarditis. Gastrointestinal reactions:
Glossitis, stomatitis, nausea, emesis, abdominal pains, hepatitis, diarrhea
and pancreatitis. CVS reactions: Headache, peripheral neuritis, mental
depression, convulsions, ataxia, hallucinations, tinnitus, vertigo, insomnia,
apathy, fatigue, muscle weakness and nervousness. Miscellaneous reac-
tions: Drug fever, chills, toxic nephrosis with oliguria and anuria, periar-
teritis nodosa andL.€. phenomenon. Duetocertain chemical similarities to
some goitrogens, diuretics (acetazolamide, thiazides) and oral hypogly-

tion, diuresis and hypoglycemia; cross-sensitivity may exist with these
agents. In rats, long-term therapy with sulfonamides has produced thyroid
malignancies.

Dosage: Not recommended for children under 12. Usual adult dosage: 1
SeptraDS tablet or 2 Septraplaintablets or 4 teaspoonfuls (20 ml) every 12
hours for 10 to 14 days. Shake suspension well before using.

For patients with renal impairment:

Creatinine Clearance (ml/min) Recommended Dosage Regimen
Above 30 Usual standard regimen
1 DS tablet, 2 tablets or 4 teaspoonfuls
15-30 (20 ml) every 24 hours

Supplied: Septra DS (Double Strength) tablets containing 160 mg trimeth-
oprim and 800 mg sulfamethoxazole — bottles of 60 tablets. Septra tablets
containing 80 mg trimethoprim and 400 mg sulfamethoxazole — bottles of
40, 100, 500, and 1000 tablets and strip packages of 100 individually
packed tablets. Oral suspension, containing the equivalent of 40 mg
trimethoprim and 200 mg sulfamethox-

azole in each teaspoonful (5 ml), cherry

flavored—bottles of 450 ml. Wellcome

Research Triangle Park
North Carolina 27709

cemic agents, sulfonamides have caused rare instances of goiter produc-

Burroughs Wellcome Co.

VA

In concluding that commercial speech, like other va-
rieties, is protected, we of course do not hold that it can
never be regulated in any way. Some forms of com-
mercial speech regulation are surely permissible. We
mention a few only to make clear that they are not be-
fore us and therefore are not foreclosed by this case.

They will go from one pharmacist to another, follow-
ing the discount, and destroy the pharmacist-
customer relationship. They will lose respect for the
profession because it advertises.

There is no claim, for example, that the prohibition on
prescription drug price advertising is a mere time, place,
and manner restriction. We have often approved re-
strictions of that kind provided that they are justified
without reference to the content of the regulated speech,
that they serve a significant governmental interest, and
that in so doing they leave open ample alternative chan-
nels for communication of the information. Compare
Grayned v. City of Rockford, 408 U.S. 104, 116 (1972) ;
United States v. O’Brien, 391 U. 8. 367, 377 (1968) ; and
Kovacs v. Cooper, 336 U.S. 77, 85-87 (1949), with Buck-
ley v. Valeo, supra; Erznozmk v. City of Jacksonville, 422
U.S. 205, 209 (1975) ; Cantwell v. Connecticut, 310 U.S.,
at 304-308; and Saia v. New York, 334 U.S. 558, 562
(1948). Whatever may be the proper bounds of time,
place, and manner restrictions on commercial speech,
they are plainly exceeded by this Virginia statute, which
singles out speech of a particular content and seeks to
prevent its dissemination completely.

Whatever may be the proper bounds of time, place,
and manner restrictions on commercial speech, they
are plainly exceeded by this Virginia statute, which
singles out speech of a particular content and seeks to
prevent its dissemination completely.

Nor is there any claim that prescription drug price ad-
vertisements are forbidden because they are false or
misleading in any way. Untruthful speech, commercial
or otherwise, has never been protected for its own sake.
Gertz v. Robert Welch, Inc., 418 U. S. 323, 340 (1974) ;
Konigsberg v. State Bar, 366 U. S. 36, 49 and n. 10
(1961). Obviously, much commercial speech is not prov-
ably false, or even wholly false, but only deceptive or
misleading. We foresee no obstacle to a State’s dealing
effectively with this problem.** The First Amendment,

20

as we construe it today, does not prohibit the State from
insuring that the stream of commercial information flows
cleanly as well as freely. See, for example, Va. Code
Ann. § 18.2-216 (1975).

What is at issue is whether a State may completely
suppress the dissemination of concededly truthful
information about entirely lawful activity, fearful of
that information’s effect upon its disseminators and
its recipients.

Also, there is no claim that the transactions pro-
posed in the forbidden advertisements are themselves
illegal in any way. Cf. Pittsburgh Press Co. v. Pitts-
burgh Comm’n on Human Relatwns, supra; United
States v. Hunter, 459 F. 2d 205 (CA4), cert. denied, 409
U. S. 934 (1972). Finally, the special problems of the
electronic broadcast media are likewise not in this case.
Cf. Capitol Broadcasting Co. v. Mitchell, 333 F. Supp.
582 (DC 1971), aff’d sub nom. Capitol Broadcasting Co.
v. Acting Attorney General, 405 U.S. 1000 (1972).

What is at issue is whether a State may completely
suppress the dissemination of concededly truthful infor-
mation about entirely lawful activity, fearful of that
information’s effect upon its disseminators and its recipi-
ents. Reserving other questions,”® we conclude that the
answer to this one is in the negative.”

The judgment of the District Court is affirmed.

It ws so ordered.

Mr. Justice STEVENS took no part in the considera-
tion or decision of this case.

Me. Curer JUSTICE BuRGER, concurring.

The Court notes that roughly 95% of all prescriptions
are filled with dosage units already prepared by the
manufacturer and sold to the pharmacy in that form.
These are the drugs that have a market large enough to
make their preparation profitable to the manufacturer;
for the same reason, they are the drugs that it is profit-
able for the pharmacist to advertise. In dispensing
these items, the pharmacist performs three tasks: he
finds the correct bottle; he counts out the correct num-
ber of tablets or measures the right amount of liquid;
and he accurately transfers the doctor’s dosage instruc-
tions to the container. Without minimizing the poten-
tial consequences of error in performing these tasks or
the importance of the other tasks a professional pharma-
cist performs, it is clear that in this regard he no more
renders a true professional service than does a clerk who
sells lawbooks.

THE MARYLAND PHARMACIST

Without minimizing the potential consequences of
error in performing these tasks or the importance of
other tasks a professional pharmacist performs, it is
clear that in this regard he no more renders a true
professional service than a clerk who sells lawbooks.

Our decision today, therefore, deals largely with the
State’s power to prohibit pharmacists from advertising
the retail price of prepackaged drugs. As the Court
notes, ante, at 25 n. 25, quite different factors would gov-
ern were we faced with a law regulating or even prohibit-
ing advertising by the traditional learned professions of
medicine or law. “The interest of the States in regulat-
ing lawyers is especially great since lawyers are essential
to the primary governmental function of administering
justice, and have historically been ‘officers of the courts.’ ”
Goldfarb v. Virginia State Bar, 421 U.S. 773, 792 (1975).
See also Cohen v. Hurley, 366 U.S. 117, 123-124 (1961).
We have also recognized the State’s substantial interest
in regulating physicians. See. e. g., United States v.
Oregon Medical Society, 343 U. S. 326, 336 (1952):
Semler v. Oregon State Board of Dental Examiners, 294
U. S. 608, 612 (1935). Attorneys and physicians are
engaged primarily in providing services in which profes-
sional judgment is a large component, a matter very
different from the retail sale of labeled drugs already
prepared by others.

Attorneys and physicians are engaged primarily in
providing services in which professional judgment is
a large component, a matter very different from the
retail sale of labeled drugs already prepared by others.

Mr. JusTICE STEWART aptly observes that the “differ-
ence between commercial price and product advertis-
ing... and ideological communication” allows the state
a scope in regulating the former that would be unaccept-
able under the First Amendment with respect to the
latter. I think it important to note also that the adver-
tisement of professional services carries with it quite
different risks than the advertisement of standard prod-
ucts. The Court took note of this in Semler, 294 U.S...
at 612, in upholding a state statute prohibiting entirely
certain types of advertisement by dentists:

“The legislature was not dealing with traders in
commodities, but with the vital interest of public
health, and with a profession treating bodily ills
and demanding different standards of conduct. from
those which are traditional in the competition of

UNE, 1976

the market place. The community is concerned
with the maintenance of professional standards
which will insure not only competency in individual
practitioners, but protection against those who would
prey upon a public peculiarly susceptible to imposi-
tion through alluring promises of physical relief.
And the community is concerned in providing safe-
guards not only against deception, but against prac-
tices which would tend to demoralize the profession
by forcing its members into an unseemly rivalry
which would enlarge the opportunities of the least
scrupulous.”

enn ee SSS

! doubt that we know enough about evaluating the
quality of medical and legal services to know which
claims of superiority are ‘misleading’ and which are
justifiable.

SS SSS

I doubt that we know enough about evaluating the
quality of medical and legal services to know which
claims of superiority are ‘misleading’ and whieh are
justifiable. Nor am I sure that even advertising the
price of certain professional services is not inherently
misleading, since what the professional must do will vary
greatly in individual cases. It is important to note that
the Court wisely leaves these issues to another day.

Mr. Justice Stewart, concurring.

In Thornhill v. Alabama, 310 U. S. 88, the Court ob-
served that “[f]reedom of discussion, if it would fulfill its
historic function in this nation, must embrace all issues
about which information is needed or appropriate to en-
able the members of society to cope with the exigencies
of their period.” Jd., at 102. Shortly after the Thorn-
hall decision, the Court identified a single category of
communications that is constitutionally unprotected:
communications “which by their very utterance inflict
injury.” Chaplinsky v. New Hampshire, 315 U. S. 568,
572. Yet only a month after Chaplinsky, and without
reference to that decision, the Court stated in Valentine
v. Chrestensen, 316 U.S. 52, 54, that “the Constitution
imposes no such restraint on government as respects
purely commercial advertising.’ For more than 30 years
this “casual, almost offhand” statement in Valentine has
operated to exclude commercial speech from the protec-
tion afforded by the First Amendment to other types of
communication. Cammarano vy. United States, 358 U.S.
498, 514 ( Douglas, J., concurring) .’

But since it is a cardinal principle of the First Amend-
ment that ‘government has no power to restrict ex-
pression because of its message, its ideas, or its sub-
ject matter, or its content .. .’

| SS TE | SR Re ee Se ee

(Continued on Page 23)

21

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Today the Court ends the anomolous situation created
by Valentine and holds that a communication which does
no more than propose a commercial transaction is not
“wholly outside the protection of the First Amendment.”
Ante, at 12. But since it is a cardinal principle of the
First Amendment that “government has no power to re-
strict expression because of its message, its ideas, its sub-
ject matter, or its content,” the Court’s decision calls
into immediate question the constitutional legitimacy of
every state and federal law regulating false or deceptive
advertising. I write separately to explain why I think
today’s decision does not preclude such governmental
regulation.

The Court has on several occasions addressed the prob-
lem posed by false statements of fact in libel cases.
Those cases demonstrate that even with respect to ex-
pression at the core of the First Amendment, the Consti-
tution does not provide absolute protection for false fac-
tual statements that cause private injury. In Gertz vy.
Robert Welch, Inc., 418 U. S. 323, 340, the Court con-
cluded that “there is no constitutional value in false
statements of fact.” As the Court had previously recog-
nized in New York Times Co. v. Sullivan, 376 U.S. 254,
however, factual errors are inevitable in free debate, and
the imposition of lability for erroneous factual assertions
can “dampen[] the vigor and limit{] the variety of
public debate’ by inducing “self-censorship.” J/d., at
279. In order to provide ample “breathing space” for
free expression, the Constitution places substantial lim-
itations on the discretion of government to permit re-
covery for libelous communications. See Gertz v. Robert
Welch, Inc., supra, at 347-349.

The advertiser's access to the truth about his product
and its price substantially eliminates any danger that
governmental regulation of false or misleading price
or product advertising will chill accurate and non-
deceptive commercial expression.

The principles recognized in the libel decisions suggest
that government may take broader action to protect the
public from injury produced by false or deceptive price
or product advertising than from harm caused by
defamation. In contrast to the press, which must often
attempt to assemble the true facts from sketchy and some-
times conflicting sources under the pressure of publica-
tion deadlines, the commercial advertiser generally knows
the product or service he seeks to sell and is in a position
to verify the accuracy of his factual representations be-
fore he disseminates them. The advertiser's access to
the truth about his product and its price substantially
eliminates any danger that governmental regulation of

23

false or misleading price or product advertising will chill
accurate and nondeceptive commercial expression. There
is, therefore, little need to sanction “some falsehood in
order to protect speech that matters.” Gertz v. Robert
Welch, Inc., supra, at 341.

The scope of constitutional protection of communica-
tive expression is not universally inelastic. In the area
of labor relations, for example, the Court has recognized
that “an employer’s free speech right to communicate
his views to his employees is firmly established and can-
not be infringed by a union or the [NLRB].” NZRB v.
Gissel Packing Co., 395 U. S. 575, 617. See NLRB v.
Virgina Electric & Power Co., 314 U. S. 469. Yet. in
that context, the Court has concluded that the em-
ployer’s freedom to communicate his views to his
employees may be restricted by the requirement that
any predictions “be carefully phrased on the basis of
objective fact.’* Jd., at 618. In response to the con-
tention that the “lne between so-called permitted pre-
dictions and proscribed threats is too vague to stand up
under traditional First Amendment analysis.” the Court
relied on the employer’s intimate knowledge of the
employer-employee relationship and his ability to “avoid
coercive speech simply by avoiding conscious overstate-
ments he has reason to believe will mislead his em-
ployees.” Jd., at 620. Cf. United States v. 95 Barrels
of Vinegar, 265 U. S. 488, 443 (“It is not difficult to
choose statements, designs and devices which will not
deceive.”). Although speech in the labor relations set-
ting may be distinguished from commercial advertising!
the Gissel Packing Co. opinion is highly significant in
the present context because it underscores the constitu-
tional importance of the speaker’s specific and unique
knowledge of the relevant facts and establishes that a
regulatory scheme monitoring “the impact of utterances”
is not invariably inconsistent with the First Amendment.°
See 395 U. S., at 620.

SS SSS

The Court’s determination that commercial advertis-
ing of the kind at issue here is not ‘wholly outside the
protection of’ the First Amendment indicates by its
very phrasing that there are important differences be-
tween commercial price and product advertising, on
the one hand, and ideological communication on the
other.

Ee

The Court’s determination that commercial advertis-
ing of the kind at issue here is not “wholly outside the
protection of” the First Amendment indicates by its very
phrasing that there are important differences between
commercial price and product advertising, on the one
hand, and ideological communication on the other. See
ante, at 23-24, n, 24. Ideological expression, be it oral,

24

literary, pictorial, or theatrical, is integrally related to
the exposition of thought—thought that may shape our
concepts of the whole universe of man. Although such
expression may convey factual information relevant to
social and individual decisionmaking, it is protected by |
the Constitution, whether or not it contains factual repre-
sentations and even if it includes inaccurate assertions of |
fact. Indeed, disregard of the “truth” may be employed |
to give force to the underlying idea expressed by the
speaker.° “Under the First Amendment there is no such |
thing as a false idea.’ and the only way that ideas can
be suppressed is through ‘the competition of other ideas.”
Gertz v. Robert Welch, Inc., supra, at 339-340.

EEE

‘Under the First Amendment there is no such thing as
a false idea’ and the only way that ideas can be sup-
pressed is through ‘the competition of other ideas.’

SS

Commercial. price and product advertising differs
markedly from ideological expression because it is con-
fined to the promotion of specific goods or services.’
The First Amendment protects the advertisement be-
cause of the “information of potential interest and value”
conveyed, Bigelow v. Virginia, 421 U.S. 809, 822, rather
than because of any direct contribution to the inter-
change of ideas. See ante, at 14-17, 22° Since the
factual claims contained in commercial price or product
advertisements relate to tangible goods or services, they
may be tested empirically and corrected to reflect the
truth without in any manner jeopardizing the free dis-
semination of thought. Indeed, the elimination of false
and deceptive claims serves to promote the one facet of
commercial price and product advertising that warrants
First Amendment protection—its contribution to the
flow of accurate and reliable information relevant to
public and private decisionmaking.

Mr. Justice REHNQUIST, dissenting.

The logical consequences of the Court’s decision in
this case, a decision which elevates commercial inter-
course between a seller hawking his wares and a buyer
seeking to strike a bargain to the same plane as has been
previously reserved for the free marketplace of ideas,
are far reaching indeed. Under the Court’s opinion the
way will be open not only for dissemination of price in-
formation but for active promotion of prescription drugs,
liquor, cigarettes and other products the use of which it
has previously been thought desirable to discourage.
Now, however, such promotion is protected by the First
Amendment so long as it is not misleading or does not
promote an illegal product or enterprise. In coming to
this conclusion, the Court has overruled a legislative de-
termination that such advertising should not be allowed

THE MARYLAND PHARMACIST

and has done so on behalf of a consumer group which is

not directly disadvantaged by the statute in question.
This effort to reach a result which the Court obviously
considers desirable is a troublesome one, for two reasons.

It extends standing to raise First Amendment claims be-

_ yond the previous decisions of this Court.

It also ex-

tends the protection of that Amendment to purely com-
_ mercial endeavors which it most vigorous champions on
this Court had thought to be beyond its pale.

Under the Court’s opinion the way will be open not
only for dissemination of price information but for
active promotion of prescription drugs, liquor,
cigarettes and other products the use of which it has
previously thought desirable to discourage.

i

I do not find the question of the appellees’ standing
to urge the claim which the Court decides quite as easy
as the Court does. The Court finds standing on the part
of the consumer appellee based upon a “right to receive
information.’ Ante, pp.8-9. Yet it has been stipulated
in this case that the challenged statute does not forbid
anyone from receiving this information either in person
or by phone. Ante, p. 4. The statute forbids “only
publish[ing], advertis[ing] and promot[ing]” of pre-
scription drugs.

While it may be generally true that publication of
information by its source is essential to effective com-
munication, it is surely less true, where, as here, the

potential recipients of the information have, in the

Court’s own words, a “keen if not keener by far’ interest
in it than “in the day’s most urgent political debate.”
Ante, p. 14. Appellees who have felt so strongly about
their right to receive information as to litigate the issue
in this lawsuit must also have enough residual interest
in the matter to call their pharmacy and inquire.

Appellees who have felt so strongly about their right
to receive information as to litigate the issue in this
lawsuit must also have enough residual interest in the
matter to call their pharmacy and inquire.

The statute, in addition, only forbids pharmacists
from publishing this price information. There is no
prohibition against a consumer group, such as appellees,
collecting and publishing comparative price information
as to various pharmacies in an area. Indeed they have
done as much in their briefs in this case. Yet, though

JUNE, 1976

appellees could both receive and publish the information
in question the Court finds that they have standing to
protest that pharmacists are not allowed to advertise.
Thus, contrary to the assertion of the Court, appellees
are not asserting their “right to receive information” at
all but rather the right of some third party to publish.
In the cases relied upon by the Court, ante, pp. 8-9, the
plaintiffs asserted their right to receive information
which would not be otherwise reasonably available to
them.* They did not seek to assert the right of a third
party, not before the Court, to disseminate information.
Here, the only group truly restricted by this statute, the
pharmacists, have not even troubled to join in this litiga-
tion and may well feel that the expense and competition
of advertising is not in their interest.

II

Thus the issue on the merits is not, as the Court
phrases it, whether “our pharmacist”? may communicate
the fact that he “will sell you the X prescription drug at
Y price.” No pharmacist is asserting any such claim to
so communicate. The issue is rather whether appellee
consumers may override the legislative determination
that pharmacists should not advertise even though the
pharmacists themselves do not object. In deciding that
they may do so, the Court necessarily adopts a rule which
cannot be limited merely to dissemination of price alone,
and which cannot possibly be confined to pharmacists
without likewise extending to lawyers, doctors and all
other professions.

The Court necessarily adopts a rule which cannot be
limited merely to dissemination of price alone, and
which cannot possibly be confined to pharmacists
without likewise extending to lawyers, doctors, and
all other professions.

The Court speaks of the consumer’s interest in the free
flow of commercial information, particularly in the case
of the poor, the sick, and the aged. It goes on to observe
that “society also may have a strong interest in the free
flow of commercial information.’ Ante, p. 15. One
need not disagree with either of these statements in order
to feel that they should presumptively be the concern
of the Virginia Legislature, which sits to balance these
and other claims in the process of making laws such as
the one here under attack. The Court speaks of the
importance in a “predominantly free enterprise economy’
of intelligent and well-informed decisions as to allocation
of resources. Ante, p. 16. While there is again much
to be said for the Court’s observation as a matter of de-
sirable public policy, there is certainly nothing in the

#4.)

United States Constitution which requires the Virginia
Legislature to hew to the teachings of Adam Smith in its
legislative decisions regulating the pharmacy profession.
E. g., Nebbia v. New York, 297 U. S. 562; Olsen v.
Nebraska, 313 U.S. 236.

As Mr. Justice Black, writing for the Court, observed
in Ferguson v. Skrupa, 372.U. 8. 726, 730 (1963):

“The doctrine ... that due process authorizes courts
to hold laws unconstitutional when they believe the
legislature has acted unwisely has long since been
discarded. We have returned to the original con-
stitutional proposition that courts do not substitute
their social and economic beliefs for the judgment
of legislative bodies who are elected to pass law.”

Similarly in Williamson v. Lee Optical Co., 348 U.S.
483, 489-490 (1955), the Court, in dealing with a state
prohibition against the advertisement of eyeglass frames,
held that “[wJe see no constitutional reason why a State
may not treat all who deal with the human eye as mem-
bers of a profession who should use no merchandising
methods for obtaining customers.” 348 U.S., at 490.

The Court addresses itself to the valid justifications
which may be found for the Virginia statute, and appar-
ently discounts them because it feels they embody a
“highly paternalistic approach.” Ante, p. 21. It con-
cludes that the First Amendment requires that channels
of advertising communication with respect to prescrip-
tion drugs must be opened, and that Virginia may not
keep “‘the public in ignorance of the entirely lawful terms
that pharmacists are offering.” Ante, p. 21.

! cannot distinguish between the public’s right to
know the price of drugs and its right to know the price
of title searches or physical examinations or other
professional services for which standardized fees are
charged.

The Court concedes that legislatures may prohibit
false and misleading advertisements, and may likewise
prohibit advertisements seeking to induce transactions
which are themselves illegal. In a final footnote the
opinion tosses a bone to the traditionalists in the legal
and medical professions by suggesting that because they
sell services rather than drugs the holding of this case is
not automatically applicable to advertising in those pro-
fessions. But if the sole limitation on permissible state
proscription of advertising is that it may not be false or
misleading, surely the difference between pharmacists’
advertising and lawyers’ and doctors’ advertising can be
only one of degree and not of kind. I cannot distinguish
between the public’s right to know the price of drugs
and its right to know the price of title searches or phys-
ical examinations or other professional services for

26

which standardized fees are charged. Nor is it apparent
how the pharmacists in this case are less engaged in a
regulatable profession than were the opticians in Wil-
liamson, supra.

.. . Our hypothetical pharmacist may now presuma-
bly advertise not only prices of prescription drugs, but
may attempt to energetically promote their sale so
long as he does so truthfully.

Nor will the impact of the Court’s decision on existing
commercial and industrial practice be limited to allowing
advertising by the professions. The Court comments
that in labor disputes “it has long been settled that both
the employee and the employer are protected by the
First Amendment when they express themselves on the
merits of the dispute in order to influence its outcome.”
Ante, p. 13. But the first case cited by the Court in
support of this proposition, NLRB vy. Gissel Packing Co.,
395 U.S. 575, 617-618, falls a good deal short of support-
ing this general statement. The Court there said that
“an employer is free to communicate to his employees
any of his general views about unionism or any of his
specific views about a particular union, so long as the
communications do not contain a ‘threat of reprisal or
force or promise of benefit.’” 395 U. S., at 618. This
carefully guarded language is scarcely a ringing endorse-
ment of even the second class First Amendment rights
which the Court has today created in commercial speech.

It is hard to see why an employer’s right to publicize
a promise of benefit may be prohibited by federal law,
so long as the promise is neither false nor deceptive, if
pharmacists’ price advertising may not be prohibited by
the Virginia legislature. Yet such a result would be
wholly inconsistent with established labor law.

Both the Courts of Appeals and the National Labor
Relations Board have not hesitated to set aside repre-
sentation elections in which the employer made state-
ments which were undoubtedly truthful but which were
found to be implicitly coercive. For instance, in NERB
v. Realist, Inc., 328 F. 2d 840 (CA7 1964), an election
was set aside when the employer, in a concededly non-
threatening manner, raised the spectre of plant closings
which would result from unionism. In Oak Manufac-
turing Co., 141 N. L. R. B. 1323 (1963), the Board set
aside an election where the employer stated “categori-
cally” that the union “cannot and will not obtain any
wage increase for you,” and with respect to seniority
said that it could “assure” the employees that the union’s
program “will be worse than the present system.” In
Freeman Manufacturing Co., 148 N. L. R. B. 68 (1964),
the employer sent letters to employees in which he urged
that unionization might cause customers to cease buying

(Continued on Page 29)

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the company’s product because of delays and higher
prices. The Board found this to be grounds for invali-
dating the election. Presumably all of these holdings
will require re-evaluation in the light of today’s decision
with a view toward allowing the employer’s speech be-
cause it is now protected by the First Amendment, as
expanded by this decision.

There are undoubted difficulties with an effort to draw
a bright line between “commercial speech” on the one
hand and “protected speech” on the other, and the Court
does better to face up to these difficulties than to attempt
to hide them under labels. In this case, however, the
Court has unfortunately substituted for the wavering
line previously thought to exist between commercial
speech and protected speech a no more satisfactory line
of its own—that between “truthful” commercial speech,
on the one hand, and that which is “false and mislead-
ing” on the other. The difficulty with this line is not
that it waivers, but on the contrary that it is simply too
Procrustean to take into account the congeries of factors

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which I believe could, quite consistently with the First
and Fourteenth Amendments, properly influence a legis-
lative decision with respect to commercial advertising.
The Court insists that the rule it lays down is consist-
ent even with the view that the First Amendment is “pri-
marily an instrument to enlighten public decisionmaking
in a democracy.” Ante, p. 16. I had understood this
view to relate to public decisionmaking as to political,
social, and other public issues, rather than the decision
of a particular individual as to whether to purchase one
or another kind of shampoo. It is undoubtedly arguable
that many people in the country regard the choice of
shampoo as just as important as who may be elected to
local, state, or national political office, but that does
not automatically bring information about competing
shampoos within the protection of the First Amendment.
It is one thing to say that the line between strictly ideo-
logical and political commentaries and other kinds of
commentary is difficult to draw, and that the mere fact
that the former may have in it an element of commer-
cialism does not strip it of First Amendment protection.

JUNE, 1976

See New York Times v. Sullivan, 376 U. S. 254. But
it is another thing to say that because that line is diffi-
cult to draw, we will stand at the other end of the spec-
trum and reject out of hand the observation of so dedi-
cated a champion of the First Amendment as Mr. Justice
Black that the protections of that Amendment do not
apply to a “‘merchant’ who goes from door to door ‘sell-
ing pots.” Breard v. City of Alexandria, 341 U.S. 622,
650 (Black, J., dissenting).

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In the case of “our” hypothetical pharmacist, he may
now presumably advertise not only the prices of pre-
scription drugs, but may attempt to energetically pro-
mote their sale so long as he does so truthfully. Quite
consistently with Virginia law requiring prescription
drugs to be available only through a physician, “‘our”
pharmacist might run any of the following representa-
tive advertisements in a local newspaper:

“Pain getting you down? Insist that your physician
prescribe demerol. You pay a little more than for
aspirin, but you get a lot more relief.”

“Can’t shake the flu? Get a prescription for tetra-
cycline from your doctor today.”

“Don’t spend another sleepless night. Ask your
doctor to prescribe Seconal without delay.”

Unless the State can show that these advertisements
are either actually untruthful or misleading, it presum-
ably is not free to restrict in any way commercial efforts
on the part of those who profit from the sale of prescrip-
tion drugs to put them in the widest possible circulation.
But such a line simply makes no allowance whatever for
what appears to have been a considered legislative judg-
ment in most States that while prescription drugs are a

. . .Aconsidered legislative judgment in most States
that while prescription drugs are a necessary and vital
part of medical care and treatment, there are suffi-
cient dangers attending their widespread use that
they simply may not be promoted in the same manner
as hair creams, deodorants, and toothpaste.

necessary and vital part of medical care and treatment,
there are sufficient dangers attending their widespread
use that they simply may not be promoted in the same
manner as hair creams, deodorants, and toothpaste. The
very real dangers that general advertising for such drugs
might create in terms of encouraging, even though not

(Continued on Page 31)

29

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sanctioning, illicit use of them by individuals for whom
they have not been prescribed, or by generating patient
pressure upon physicians to prescribe them, are simply
not dealt with in the Court’s opinion. If prescription
drugs may be advertised, they may be advertised on tele-
vision during family viewing time. Nothing we know
about the acquisitive instincts of those who inhabit every
business and profession to a greater or lesser extent gives
any reason to think that such persons will not do every-
thing they can to generate demand for these products in
much the same manner and to much the same degree as
demand for other commodities has been generated.

Both Congress and state legislatures have by law
sharply limited the permissible dissemination of informa-
tion about some commodities because of the potential
harm resulting from those commodities, even though
they were not thought to be sufficiently demonstrably
harmful to warrant outright prohibition at their sale.
Current prohibitions on television advertising of liquor
and cigarettes are prominent in this category, but ap-
parently under the Court’s holding so long as the adver-
tisements are not deceptive they may no longer be
prohibited.

The very real dangers that general advertising for such
drugs might create in terms of encouraging, even
though not sanctioning, illicit use of them by indi-
viduals for whom they have not been prescribed, or
by generating patient pressure upon physicians to
prescribe them, are simply not dealt with in the
Court’s opinion.

This case presents a fairly typical First Amendment
problem—that of balancing interests in individual free
speech against public welfare determinations embodied in
a legislative enactment. As the Court noted in American
Comm. Assn. v. Douds, 339 U. S. 382, 399 (1950),

“TLjegitimate attempts to protect the public, not
from the remote possible effects of noxious ideolo-
gies, but from the present excesses of direct, active
conduct are not presumptively bad because they
interfere with and, in some of its manifestations, re-
strain the exercise of First Amendment rights.”

Here the rights of the appellees seem to me to be
marginal at best. There is no ideological content to the
information which they seek and it is freely available to
them—they may even publish it if they so desire. The
only persons directly affected by this statute are not par-
ties to this lawsuit. On the other hand, the societal
interest against the promotion of drug use for every ill,
real or imaginary, seems to me extremely strong. I do
not believe that the First Amendment mandates the
Court’s “open door policy” toward such commercial
advertising.

JUNE, 1976

FOOTNOTES

‘The First Amendment is applicable to the States through the
Due Process Clause of the Fourteenth Amendment. See, e. g.,
Bigelow v. Virginia, 421 U.S. 809, 811 (1975); Schneider v. State,
308 U.S. 147, 160 (1939).

2 § 54-524.35 provides in full:

“Any pharmacist shall be considered guilty of unprofessional con-
duct who (1) is found guilty of any crime involving grave moral
turpitude, or is guilty of fraud or deceit in obtaining a certificate
of registration; or (2) issues, publishes, broadcasts by radio, or
otherwise, or distributes or uses in any way whatsoever advertising
matter in which statements are made about his professional service
which have a tendency to deceive or defraud the public, contrary
to the public health and welfare; or (3) publishes, advertises or
promotes, directly or indirectly, in any manner whatsoever, any
amount, price, fee, premium, discount, rebate or credit terms for
professional services or for drugs containing narcotics or for any
drugs which may be dispensed only by prescription.”

3 The parties, also, have stipulated that pharmacy “‘is a profes-
sion.” Stipulation of Facts 11, App. 11.

*Id., 48, App. 11. See generally id., {§ 6-16, App. 10-12.

° Exception is made for “legally qualified” practitioners of medi-
cine, dentistry, osteopathy, chiropody, and veterinary medicine.
§ 54-524.53.

6 Stipulation of Facts ¥ 25, App. 15.

7Id., $18, App. 13.

8 Theretofore an administrative regulation to the same effect had
been outstanding. The Board, however, in 1967 was advised by the
State’s Attorney General’s office that the regulation was unauthor-
ized. The challenged phrase was added to the statute the following
year. See Patterson Drug Co. v. Kingery, 305 F. Supp. 821, 823
n. 1 (WD Va. 1969).

® Stipulation of Facts 3, App. 9.

10 The organizations are the Virginia Citizens Consumer Council,
Inc., and the Virginia State AFL-CIO. Each has a substantial
membership (approximately 150,000 and 69,000, respectively) many
of whom are users of prescription drugs. Stipulation of Facts
§{ 1 and 2, App. 9. The American Association of Retired Persons
and the National Retired Teachers Association, also claiming many
members who “depend substantially on prescription drugs for their
well-being,” Brief 2, are among those who have filed bnefs amici
curiae in support of the appellees.

11 Stipulation of Facts {J 22 (b) and (c), App. 14. The phenom-
enon of widely varying drug prices is apparently national in scope.
The American Medical Association conducted a survey in Chicago
that showed price differentials in that city of up to 1200% for the
same amounts of a specific drug. A study undertaken by the Con-
sumers Union in New York found that prices for the same amount
of one drug ranged from 79¢ to $7.45, and for another from $1.25
to $11.50. Id., §§ 22 (d) and (e), App. 14. Amici American Asso-
ciation of Retired Persons and National Retired Teachers Associa-
tion state that in 1974 they participated in a survey of presenption
drug prices at 28 pharmacies in Washington, D. C., and found
pharmacy-to-pharmacy variances in the price of identical drugs as
great as 245%. Brief 10. The prevalence of such discrepancies
“throughout the United States” is documented in a recent report.
Staff Report to the Federal Trade Commission, Prescription Drug
Price Disclosures 119 (1975). The same report indicates that 34
States impose significant restrictions on dissemination of drug price
information and, thus, make the problem a national one. /d., at 34.

12 The Florida and Pennsylvania decisions appear to rest on state
constitutional grounds. The Maryland decision was based on the
Due Process Clause of the Fourteenth Amendment as well as on
provisions of the state constitution.

(Continued on Page 33)

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Accord: Terry v. California State Board of Pharmacy, 395 F.
Supp. 94 (ND Cal. 1975), appeal pending, No. 75-336. Contra:
Urowsky v. Board of Regents, 46 A. D. 2d 974, 362 N. Y. S. 2d
46 (1974) ; Supermarkets General Corp. v. Sills, 93 N. J. Super. 326,
225 A. 2d 728 (1966).

See Note: Commercial Speech—an End in Sight to Chrestensen?
23 DePaul L. Rev. 1258 (1974); Comment, 37 Brooklyn L. Rev.
617 (1971); Comment, 24 Wash. and Lee L. Rev. 299 (1967).

13In Head v. New Mexico Board, 374 U.S. 424 (1963), the First
Amendment issue was raised. This Court refused to consider it,
however, because it had not been presented to the state courts, nor
reserved in the notice of appeal here. Jd., at 432 n. 12. The
Court’s action to this effect was noted in Pittsburgh Press Co. v.
Pittsburgh Comm’n on Human Relations, 413 U. S. 376, 387 n. 10
(1973). The appellant at the oral argument recognized that Head
was a due process case. Tr. of Oral Arg. 10.

1#“In the absence of Section 54-524.35 (3), some pharmacies in
Virginia would advertise, publish and promote price information
regarding prescription drugs.” Stipulation of Facts § 26, App. 15.

© The dissent contends that there is no such right to receive the
nformation that another secks to disscminate, at least not when
he person objecting could obtain the information in another way,
und could himself disserninate it. Our prior decisions, cited above,
ire said to have been limited to situations in which the information
sought to be received “would not be otherwise available”; emphasis
is also placed on the appellees’ great need for the information, which
need, assertedly, should cau-e them to take advantage of the alter-
native of digging it up themselves. We are aware of no general
principle that freedom of speech may be abridged when the speak-
er’s listeners could come by his message by some other means, such
as seeking him out and asking him what it is. Nor have we
recognized any such limitation on the independent right of the
listener to receive the information sought to be communicated.
Certainly, the recipients of the political publications in Lamont
could have gone abroad and thereafter disseminated them them-
selves. Those in Klezndvenst who organized the lecture tour by a
foreign Marxist could have done the same. And the addressees of
the inmate correspondence in Procunier could have visited the prison
themselves. As for the recipients’ great need for thé information
sought to be disseminated, if it distinguishes our prior cases at all,
it makes the appellees’ First Amendment claim a stronger rather
than a weaker one.

See Bigelow v. Virginia, 421 U. S., at 820 n. 6, citing Mr.

Justice Douglas’ observation in Cammarano v. United States, 358
U. S. 498, 514 (1959) (concurring opinion), that the Chrestensen
ruling ‘was casual, almost offhand. And it has not survived reflec-
tion”; the similar observation of four Justices in dissent in Lehman
v. City of Shaker Heights, 418 U. S. 298, 314 n. 6 (1974); and
expressions of three Justices in separate dissents in Pittsburgh Press
Co. v. Pittsburgh Comm’n on Human Relations, 413 U. S., at 393,
398, and 401. See also Mr. Justice Douglas’ comment, dissenting
from the denial of certiorari, in Dun & Bradstreet, Inc. v. Grove,
404 U.S. 898, 904-906 (1971).
The speech of labor disputants, of course, is subject to a num-
ber of restrictions. The Court stated in NLRB v. Gissel Packing
Co., 395 U. S. 575, 618 (1969), for example, that an employer’s
threats of retaliation for the labor actions of his employees are “with-
nut the protection of the First Amendment.’”’ The constitutionality
of restrictions upon speech in the special context of labor disputes is
not before us here. We express no views on that complex subject,
and advert to cases in the labor field only to note that in some
circumstances speech of an entirely private and economic character
enjoys the protection of the First Amendment.

‘6 The point hardly needs citation, but a few figures are illustra-
tive. It has been estimated, for example, that in 1973 and 1974
per capita drug expenditures of persons over the age of 65 were
$97.27 and $103.17, respectively, more than twice the figures of
$41.18 and $45.14 for all age groups. Cooper & Piro, Age Differ-
ences in Medical Care Spending, Fiscal Year 1973, Social Security

UNE, 1976

Bulletin, HEW, SSA, Volume 37, No. 5, at 6 (1974); Mueller &
Gibson, Age Differences in Health Care Spending, Fiscal Year 1974,
Social Security Bulletin, HEW, SSA, Volume 38, No. 6, at 5 (1975).
These figures, of course, reflect the higher rate of illness among the
aged. In 1971, 169% of all Americans over the age of 65 were
unable to carry on major activities because of some chronic condi-
tion, the figure for all ages being only 2.9%. Social Indicators,
1973, Statistical Policy Division, Office of Management and Budget 36
(1973). These figures eloquently suggest the diminished capacity of
the aged for the kind of active comparison shopping that a ban on
advertising makes necessary or desirable. Diminished resources are
also the general rule for those over 65; their income averages about
half that for all age groups. Social Indicators, supra, at 176.

The parties have stipulated that a “significant portion of income
of elderly persons is spent on medicine.” Stipulation of Facts § 27,
App. 15.

9 For the views of a leading exponent of this position, see
A. Meiklejohn, Free Speech and Its Relation to Self-Government
(1948). This Court likewise has emphasized the role of the First
Amendment in guaranteeing our capacity for democratic self-gov-
ernment. See New York Times Co. v. Sullivan, 376 U. S. 254,
269-270 (1964), and cases cited therein.

70 Pharmaceuticals themselves provide a not insignificant illistra-
tion. The parties have stipulated that expenditures for prescription
drugs in the United States in 1970 were estimated at $9.14 billion
Stipulation of Facts §17, App. 12. It has been said that the figure
for drugs and drug sundries in 1974 was $9.695 billion, with that
amount estimated to be increasing about $700 million per year.
Worthington, National Health Expenditures 1929-1974, Social Secu-
rity Bulletin, HEW, SSA, Volume 38, No. 2, at 9 (1975). The
task of predicting the effect that a free flow of drug price informa-
tion would have on the production and consumption of drugs

obviously is a hazardous and speculative one. It was recently
untaken, however, by the staff of the Federal Trade Commission
in the course of its report, see n. 11, supra, on the merits of a
possible Commission rule that would outlaw drug price advertising
restrictions. The staff concluded that consumer savings would be
“of a very substantial magnitude, amounting to millions of dollars
per year.” Staff Report, at 181.

21 An argument not advanced by the Board, either in its brief
or in the testimony proffered prior to summary judgment, but which
on occasion has been made to other courts, see, e. g., Pennsylvania
State Board of Pharmacy v. Pastor, 441 Pa. 186; 272 A. 2d 487
(1971), is that the advertisement of low drug prices will result in
overconsumption and in abuse of the advertised drugs. The argu-
ment prudently has been omitted. By definition, the drugs at issue
here may be sold only on a physician’s prescription. We do not
assume, as apparently the dissent does, that simply because low
prices will be freely advertised, physicians will overprescribe, or that
pharmacists will ignore the prescription requirement.

2% Monitoring, even if pursued, is not fully effective. It is
complicated by the mobility of the patient; by his patronizing
more than one pharmacist; by his being treated by more than one
prescriber; by the availability of over-the-counter drugs; and by
the antagonism of certain foods and drinks. Stipulation of Facts
J 30-47, App. 16-19. Neither the Code of Ethics of the American
Pharmaceutical Association nor that of the Virginia Pharmaceutical
Association requires a pharmacist to maintain family prescription
records. /d., § 42, App. 18. ‘he appellant Board has never pro-
mulgated a regulation requiring such records. Jd., © 43, App. 18.

*3 Descriptions of the pharmacist’s expertise, its importance to
the consumer, and its alleged jeopardization by price advertising
are set forth at length in the numerous summaries of testimony of
proposed witnesses for the Board, and objections to testimony of
proposed witnesses for the plaintiffs, that the Board filed with the
District Court prior to summary judgment, the substance of which
appellees did not contest. App. 4, 27-48, 52-53. Bmef for Appel-
lants 4-5 and n. 2.

33

24Tn concluding that commercial speech enjoys First Amendment
protection, we have not held that it is wholly undifferentiable from
other forms. There are commonsense differences between speech
that does “no more than propose a commercial transaction” Pitts-
burgh Press Co. v. Pittsburgh Comm’n on Human Relations, 413
U. S., at 385, and other varieties. Even if the differences do not
justify the conclusion that commercial speech is valueless, and thus
subject to complete suppression by the State, they nonetheless sug-
gest that a different degree of protection is necessary to insure that
the flow of truthful and legitimate commercial information is un-
impaired. The truth of commercial speech, for example, may be
more easily verifiable by its disseminator than, let us say, news
reporting or political commentary, in that ordinarily the advertiser
seeks to disseminate information about a specific product or service
that he himself provides and presumably knows more about than
anyone else. Also, commercial speech may be more durable than
other kinds. Since advertising is the sine qua non of commercial
profits, there is little hkelihood of its being chilled by proper regula-
tion and foregone entirely.

Attributes such as these, the greater objectivity and hardiness of
commercial speech, may make it less necessary to tolerate inaccurate
statements for fear of silencing the speaker. Compare New York
Times Co. v. Sullivan, supra, with Dun & Bradstreet, Inc. v. Grove,
supra. They may also make it appropriate to require that a com-
mercial message appear in such a form, or include such additional
information, warnings and disclaimers, as are necessary to prevent
its being deceptive. Compare Miami Herald Publishing Co. v.
Tornillo, 418 U.S. 241 (1974), with Banzhaf v. FCC, 132 U.S. App.
D. C. 14, 405 F. 2d 1082 (1968), cert. denied, sub nom. Tobacco
Institute, Inc. v. FCC, 396 U. S. 842 (1969). Compare United
States v. 95 Barrels of Vinegar, 265 U.S. 438, 443 (1924) (“It is
not difficult to choose statements, designs and devices which will
not deceive.”) They may also make inapplicable the prohibition
against prior restraints. Compare New York Times Co. v. United
States, 403 U. S. 713 (1971), with Donaldson v. Read Magazine,
333 U.S. 178, 189-191 (1948); FTC v. Standard Education Society,
302 U.S. 112 (1937); EB. F. Drew & Co. v. FTC, 235 F. 2d 735,
739-740 (CA2 1956), cert. denied, 352 U. S. 969 (1957).

25 We stress that we have considered in this case the regulation
of commercial advertising by pharmacists. Although we express
no opinion as to other professions, the distinctions, historical and
functional, between professions, may require consideration of quite
different factors. Physicians and lawyers, for example, do not dis-
pense standardized products; they render professional services of
almost infinite variety and nature, with the consequent. enhanced
possibility for confusion and deception if they were to undertake
certain kinds of advertising.

1In recent years the soundness of the sweeping language of the
Valentine opinion has been repeatedly questioned. See Bigelow v.
Virginia, 421 U.S. 809, 819-821; Lehman v. City of Shaker Heights,
418 U.S. 298, 314-315 and n. 6 (BRENNAN, J., dissenting); Pitts-
burgh Press Co. v. Pittsburgh Comm’n on Human Relations, 413
U.S. 376, 398 (Douglas, J., dissenting) ; id., at 401 and n. 6 (StEw-
ART, J., dissenting); Dun & Bradstreet, Inc. v. Grove, 404 U. S.
898, 904-906 (Douglas, J., dissenting from the denial of certiorari).

* Police Department of Chicago v. Mosley, 408 U. S. 92, 95.
Bee, .-o., diudgens vo NRE —— 5 Uy Set —, slip op., at 13;
Erznoznik v. City of Jacksonville, 422 U. S. 205, 209; Pell v. Pro-
cunier, 417 U.S. 817, 828; Grayned v. City of Rockford, 408 U.S.
104, 115.

*Speech by an employer or a labor union organizer that con-
tains material misrepresentations of fact or appeals to racial preju-
dice may form the basis of an unfair labor practice or warrant the
invalidation of a certification election. See, e. g., Sewell Mfg. Co.,
138 N. L. R. B. 66; United States Gypsum Co., 130 N. L. R. B. 901:
The Gummed Products Co., 112 N. L. R. B. 1092. Such restrictions

34

would clearly violate First Amendment guarantees if applied to
political expression concerning the election of candidates to pub-|
lic office. See Vanasco v. Schwartz, —~ F. Supp. — (EDNY) (3-
judge court), aff'd, ——- U. S. ——. Other restrictions designed to
promote antiseptic conditions in the labor relations context, such
as the prohibition of certain campaigning during the 24-hour period!
preceding the election, would be constitutionally intolerable if applied.
in the political arena. Compare Peerless Plywood Co., 107)
N. L. R. B. 427, with Mills v. Alabama, 384 U. 8S. 214.

’

‘In the labor relations area, governmental regulation of expression
by employers has been justified in part by the competing First)
Amendment associational interests of employees and by the eco-
nomic dependence of employees on their employers. See NLRB y.
Gissel Packing Co., supra, at 617-618; NLRB v. Virginia Electric &
Power Co., 314 U.S. 469, 477.

*The Court is Gissel Packing Co. emphasized the NLRB’s ex-
pertise in determining whether statements by employers would
tend to mislead or coerce emplovees. 395 U. S., at 620. The
NLRB’s armamentarium for responding to material misrepresenta- |
tions and deceptive tactics includes the issuance of cease and
desist orders and the securing of restraining orders. See 29 U.S. C.|
§§ 160 (c), (j) (1970). .

®* As the Court observed in Cantwell v. Connecticut, 310 U. 8.
296, 310:

“To persuade others to his own point of view, the pleader, as we
know, at times, restorts to exaggeration, to vilification of men who
have been, or are, prominent in church or state, and even to false
statement. But the people of this nation have ordained in the
light of history, that, in spite of the probability of excesses and
abuses, these liberties are, in the long view, essential to enlightened
opinion and mght conduct on the part of the citizens of a
democracy.”

™See Note, Developments in the Law—Deceptive Advertising, 80
Harv. L. Rev. 1005, 1030-1031.

’The information about price and product conveyed by com-
mercial advertisements may of course stimulate thought and debate
about political questions. The drug price information at issue in
the present case might well have an impact, for instance, on a per-
son’s views concerning price control issues, government subsidy pro-
posals, or special health care, consumer protection, or tax legislation.

*The Court contends, ante, p. 9 n. 15, that this case is indistin-
guishable from Procunier, Kleindienst, and Lamont, in that in all
of those cases it was possible for the parties to obtain the informa-
tion on their own. In Procunier this would have entailed traveling
to a state prison; in Kleindienst and Lamont, traveling abroad.
Obviously such measures would limit access to information in a way
that the requirement of a phone call or a trip to the corner drug
store would not. |

If prescription drugs may be advertised they may be
advertised on television during family viewing time.
Nothing we know about the acquisitive instincts of |
those who inhabit every business and profession to a |
greater or lesser extent gives any reason to think that |
such persons will not do everything they can to gen- |
erate demand for these products in much the same
manner and to much the same degree as demand for
other commodities has been generated.

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MARYLAND
PHARMACIST

Official Journal of
The Maryland
Pharmaceutical
Association

JULY 1976
VOL 52
NO 7

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JULY 1976 VOL. 52 NOR?

CONTENTS

4 Editorial — Bicentennial Reflections and Projections
for Pharmacy

6 Address of 1975-76 President — Henry G. Seidman
8 Melvin N. Rubin — 1976-77 MPhA President
8 Maryland Board of Pharmacy — Pharmacy Changes

13. Drug Evaluation — Nitroglycerin Ointment 2% —
James Quinlan and Ralph Shangraw

15 School of Pharmacy Honors Convocation
15 Calendar

16 The Colonial and Revolutionary Heritage of Pharmacy
in America — David L. Cowen

18 Early Pharmacy in Baltimore — B. F. Allen

22 Annual Report of the Maryland Board of Pharmacy
28 Open Forum and News

31 Prince Georges—Montgomery County Installation

32 Alumni Association University of Maryland School
of Pharmacy — 50th Annual Banquet

35 News: Anne Arundel, Upper Bay,
BVDA, Allegany-Garrett

36 Obituaries
36 Care Drug Centers of Washington

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ADVERTISERS
27 Calvert Drug Company 5 Mayer & Steinberg, Inc.
27 District Photo Service 37 Paramount Photo Service
9-10 Geigy Pharmaceuticals 30 Pfizer Inc.
11-12 Lederle Pharmaceuticals 20-21 Pharmaceutical Manufacturer’s
3 Eli Lilly & Co., Inc. Association

14 Loewy Drug Company 29 A. H. Robins
34 Maryland News 38 The Upjohn Company
Distributing Company

Change of address may be made by sending old address (as it appears on your journal) and new address
with zip code number. Allow four weeks for changeover. APhA members — please include APhA number.

The Maryland Pharmacist is published monthly, except for January, February, and March, 1976, combined,
by the Maryland Pharmaceutical Association, 650 West Lombard Street, Baltimore, Maryland 21201. Annual
Subscription — United States and foreign, $15 a year; single copies, $1.50. Members of the Maryland
Pharmaceutical Association receive The Maryland Pharmacist each month as part of their annual member-
ship dues. Entered as second class matter December 10, 1925, at the Post Office at Baltimore, Maryland,
under the Act of March 8, 1879.

NATHAN |. GRUZ, Editor

RICHARD M. SCHULZ, Assistant Editor
Ross P. CAMPBELL, News Correspondent
HERMAN BLOOM, Photographer

OFFICERS & BOARD OF TRUSTEES
1976-77

Honorary President

MORRIS LINDENBAUM

President

MELVIN N. RUBIN—Baltimore

Vice President

JAMES W. TRUITT, JR.—Federalsburg
Treasurer

ANTHONY G. PADUSSIS—Timonium

Executive Director
NATHAN I. GRUZ—Baltimore

TRUSTEES

HENRY G. SEIDMAN, Chairman
Baltimore

LEONARD J. DeMINO (1978)
Wheaton

S. BEN FRIEDMAN (1979)
Potomac

RONALD A. LUBMAN (1979)
Baltimore

ROBERT J. MARTIN (1977)
LaVale

ROBERT E. SNYDER (1978)
Baltimore

STANLEY J. YAFFE (1977)
Odenton

EX-OFFICIO MEMBER |
WILLIAM J. KINNARD, JR.—Baltimore

HOUSE OF DELEGATES

Speaker

VICTOR H. MORGENROTH, JR.—Ellicott
City

Vice Speaker

SAMUEL LICHTER—Randallstown

Secretary
NATHAN I. GRUZ—Baltimore

MARYLAND BOARD OF PHARMACY
Honorary President |

FRANK BLOCK—Baltimore

President

I. EARL KERPELMAN—Salisbury
BERNARD B. LACHMAN—Pikesville
RALPH T. QUARLES, SR.—Baltimore
CHARLES H. TREGOE—Parkton

Secreta
ROBERT E. SNYDER—Baltimore

THE MARYLAND PHARMACIS

The one the patient takes
is never tested.

|

Surprising, perhaps, butit makes sense
when you think about it.

Obviously, the actual dose of any pre-
scription drug the patient takes cannot be
tested because it would have to be broken
down for analysis—after which it could
never be used by a patient.

This means that you depend on the
manufacturer for assurance that the dose
the patient takes is identical to the ones
which have been tested.

At each step in the manufacture of a
Lilly drug, test after test confirms the in-
gredients, formulation, purity, and
accuracy —all the critical factors that as-
sure that every Lilly medicine is just what
the doctor ordered.

Thats particularly important, as you
know. The same drug made by different
companies can be chemically identical
yet may act differently in the human body
because of the many variables in the way
the drugs are manufactured.

And, of course, government standards
alone do not assure the efficacy and con-
sistency—the quality of each drug you
dispense.

As we at Eli Lilly and Company see it,
the ultimate responsibility for quality is
ours.

For four generations we've been mak-
ing medicinesas if peoples lives depended
on them.

600090

Lilly

ELI LILLY AND COMPANY, INDIANAPOLIS, INDIANA 46206

editorial

BICENTENNIAL REFLECTIONS AND
PROJECTIONS FOR PHARMACY

The observance of our nation’s Bicentennial causes us to
reflect upon the circumstances and conditions at the time this
country was founded. It stimulates us to think of the contrasts
between 1776 and today, to try to discern what is meaningful in
the history of the past era, what lessons we may learn and what
we can expect in the future. Finally, this time of introspection
can perhaps lead us to try to make plans to meet our projections
of the future.

Let us, then, try to apply this process in some measure to the
profession of pharmacy.

In the colonial period, pharmacy — the preparation and dis-
pensing of medicine — was primarily in the hands of physicians,
their apothecary apprentices and the few apothecaries who
were produced by this system. Until American schools of phar-
macy were established beginning with the Philadelphia College
of Pharmacy in 1821, the only apothecaries with formal
academic preparation were products of European universities.

Pharmacies soon developed along the British model where
many sundry items were sold, rather than following the Euro-
pean continental model where pharmacies confined their func-
tions to pharmacy practice — manufacturing, compounding
and dispensing.

It was not until the early years of the twentieth century that
formal academic education became a universal requirement for
licensure. Establishment of more than one pharmacy by a single
owner resulted in chains and corporate non-pharmacist
ownership.

Hospital pharmacies until recent decades were usually lo-
cated in basements with much pharmacist time spent filling
ward baskets.

Until about a decade ago, pharmacy education and practice
was based upon products known as drugs or medicines, with
emphasis on the knowledge and skills to convert crude drugs
and chemical ingredients into dosage forms.

The efficiencies and economies of the pharmaceutical manu-
facturer and the introduction of complex synthetic substances
eliminated most of the compounding and most of the tradi-
tional mystique of the “corner druggist.’” The advent of con-
sumerism has removed laws such as ‘fair trade” and prohibi-
tions on advertising.

The orientation of pharmaceutical education fortunately has
changed from producing individuals primarily qualified to be
compounders and dispensers — “junior chemists’’ — to phar-
macists who are patient oriented. Our graduates have been
introduced to clinical settings and clinical data with oppor-

tunities for application of their education and training to patient
care.

At the same time that we see a decline in individual pro
prietorship of pharmacies and an increase in corporate chain)
ownership, we have had a great expansion in the institutional
pharmacy sector. There has been, therefore, a substantial
growth in the number of pharmacists in hospital pharmacy.
Concurrently, there has been a significant number of pharma-
cists motivated to establish or convert to pharmacies that em-
phasize pharmaceutical services with inventories restricted to
health related products.

But the rapid growth in the post World War II period has beer
in the traditional chain, discount chain and supermarket chair.
pharmacies.

Marginal independent pharmacies are almost gone in Mary
land. The medium and large size independents who are apply:
ing modern management techniques, combined with per.
sonalized pharmacy service are able to cope, and in most cases
flourish.

What are the portents for the future?

1. More health service through institutional and organized
forms, with pharmacy service included.
2. Continued growth of chains.

3. Continued limited growth of individually owned smal )
apothecary shops as well as medium and large independ.

ents.

4. As the percentage of employed pharmacists (now about
66% in Maryland) grows, more pharmacists will seek the
benefits and security of unions, especially if ignored by
management.

5. More pharmacist involvement in patient oriented phar:
macy services.

6. Growth of third-party pharmacy programs both private
sector and governmental, with eventually a national
health insurance system.

7. A coordinated, integrated national pharmacy organiza
tion to counterbalance big government dictatorship ir
health matters.

8. Development in the near future of closer pharmacy
industry relations for cooperation in mutual concerns.

9. In pharmaceutical education, adoption of the Doctor o
Pharmacy as the single professional degree, with prope
emphasis on clinical and socio-economic aspects o
pharmaceutical services. Ancillary personnel will be usec
to carry out routine dispensing and related function:
under pharmacist supervision.

10. Increased support of state and local pharmaceutical asso
ciations and their political action arms as pharmacist:
belatedly recognize the necessity for unified, strong ac
tion to assure professional and economic survival.

Depending upon your particular niche in the world of phar

macy, you may or may not like or agree with one observer’:
crystal ball. But barring unforeseen developments or a radica
change in the motivation of pharmacists, we may reasonabl
expect most of these predictions to unfold in our nation’s thir
century.

—Nathan |. Gruz

Members and other readers are invited to respond with thei
comments on these reflections and projections.

THE MARYLAND PHARMACIS,

MPhA
DIVIDEND CHECKS!

As a participating member inthe MPhA
Workmen’s Compensation Program,
you Can receive a return of the profits

derived from your annual
premium. Every year! Up to 35%!
Interested? Ask Us!
This plan underwritten by A. D. |.

Your American Druggists’ Insurance Co. Representative —

MAYER” STEINBERG":

. General Insurance Agents and Brokers —
NEW ADDRESS
600 REISTERSTOWN RD. BALTO.. MD.

__ (301) 484-7000

Address of 1975-76 President

ACCOMPLISHMENTS, PROBLEMS AND
RECOMMENDATIONS

Address of Henry G. Seidman
94th Annual Convention
Sheraton Fontainebleau, Ocean City, Maryland

When my term in office began last June, there were anumber
of challenges that appeared sufficiently formidable to warrant
that my year would be neither inactive, nor undemanding, nor
free of problems. And appearances were correct. It was quite
active, most demanding and there were problems. Actually, the
total year could be accurately described as a mixture of accom-
plishment and gratification, some frustrations and disappoint-
ments. | spoke at that time, a year ago, of my hopes and plans,
and | mentioned that purpose, unity, and strength would be key
words on which our activities would be built. And it was in-
teresting to note that these were not simply catch words but had
some meaningful application. In the last third of the year, ina
period of stress when our members were in imminent danger
with respect to their practices — and | speak of the MAC
(Maximum Allowable Cost) which was the government imposed
prescription price program, they responded in a unified, posi-
tive action to force a delay in the effective date while they gained
time to review and to recommend further pricing information
before implementation of the program. While most of the credit
for this successful interim action must be given to Pharmpac,
the Political Action Committee of the Maryland Pharmaceutical
Association, the basic group that answered the call for contribu-
tion of funds was made up of association members. The lesson
learned here was that if there was a time when unity and
strength had to be demonstrated effectively, this was it.

When we entered this year, it was my hope that we would
materially increase our membership. | had optimistically en-
visioned over 100 new members. We didn’t quite make this
figure, but we did reach almost 90 new members as of this date.
As we know, there isn’t a pharmacist today, regardless of his
area or sphere of practice, who doesn’t benefit from the ac-
tivities of the Maryland Pharmaceutical Association, and | be-
lieve that our constant efforts to communicate effectively with
our affiliate and associate groups will bring about a widening
ring of support. Our membership must continue to grow. With
this in mind it was my privilege during the year to represent the
Association at meetings of many pharmaceutical groups. My
local itinerary included meetings of the Allegany—Garrett
County Pharmaceutical Association, the Anne Arundel Phar-
maceutical Association, the Baltimore Metropolitan Phar-
maceutical Association, the Eastern Shore Pharmaceutical Soci-
ety, the Upper Bay Pharmaceutical Association. In each in-
stance, and many of these were dinner meetings to which my
wife was invited as well, | was most impressed with the hospital-
ity and graciousness of our hosts. Also, the business of the
meetings proved to me unequivocally that every group to which
| spoke was interested in Association affairs and offered
cooperative effort whenever called upon. We shall, | trust,

June 21, 1976

increase regular discourse with these groups and share our
concern and goals.

| was happy to have met with the Maryland Society of Hospital
Pharmacists at the combined meeting of that society and MPhA,
and | was pleased to accept invitations to meet with a number of
diverse groups throughout the year, all of them representing

some phase of pharmacy interest or related activity. In addition ©

to these related groups, | had the opportunity to attend the

Annual Meeting of the American Association of Colleges of —

Pharmacy last July in New York State, the AACP-National Boards
of Pharmacy District #2 Meeting in Washington, D. C. in De-
cember. From the deliberation of these bodies and the Ameri-
can Pharmaceutical Association will come the recom-
mendations that will provide the future path of pharmacy prac-
tice.

The AACP-APhA Task Force this time last year issued its final
report on the Continuing Competence of Pharmacists. \t is a
thorough and extremely brilliant treatise of this subject and
should be reviewed by everyone. Likewise, the release of the
Millis Report in December is expected to have a major influence
on the development of the pharmacy profession and is en-
visioned by many as its blueprint for the future. Its major con-
cepts and recommendations are must reading for pharmacists
who will be expected to make judgements on the report in the

future. All professional bodies of Pharmacy are asked to give —

serious attention to this report. It touches both pharmacy edu-
cation and pharmacy practice. The studied judgments in these
reports embody procedures for developing professional stan-
dards of practice and competence; for developing the
mechanism of applying these standards and measurement sys-
tems. We must review and examine these findings so that we
can take intelligent action.

We must also take a stand very soon on the issue of several
levels of supportive personnel, such as pharmacy technicians
and aides. We will again be faced with action on mandatory
continuing education, and a measure to make the patient pro-
file a mandatory part of every practitioner’s daily practice. Our
Association has been working for many months to shape these
proposals into suitable form for introduction as legislation or
regulations in the near future. As | stated last year, the comple-
tion of a successful legislative program needs wisdom and dili-
gence. This year, under the guidance of Richard Parker, it suc-
ceeded in both. We did not score 100% in our efforts, but we did
manage to make considerable gains. We did not gain mandatory
continuing education, but were successful in many other areas
and we did block the passage of much undesirable legislation.
We were effective and we were heard.

THE MARYLAND PHARMACIST

¥

¥

Our Pharmacy Practices Committee chaired by Mel Rubin has
been, year round, one of the most active of all committees. His
work is ongoing, extremely important, involved, and time con-
suming. Mel is well prepared for his future role. Prescription
Insurance, that is, third party plans, has had a stormy year and is
now in the thick of price and policy problems. Marvin Friedman
is handling his committee with a great deal of restraint and skill.

Our Continuing Education Committee has performed superb-
ly this year, and the compliments it elicited so rightfully go to
Dr. Ralph Shangraw, the chairman, and his committee. Under
Dr. C. Jeleff Carr, an outstanding Swain Seminar Program was
planned and conducted. The Simon Solomon Pharmacy Eco-
nomics Seminar, chaired by Dr. Francis Palumbo, was equally

well presented and accepted. The Public Relations Committee
with our best neighbor, Charles Spigelmire, constantly doing
what he does so well — selling the pharmacists of Maryland to
the public — has had another non-stop year of activity. The
Membership Committee did the job that we asked them to do
and did it well. This is always a tiresome task and a most difficult
one. Insufficient communications from one area to another is
discouraging and disappointing, but Elwin Alpern persevered
and we did, as | mentioned earlier, make a significant gain in
~membership this year.

Ron Lubman chairs the Convention and Trips Committee this
year, and this has not been an unmixed pleasure for him. Can-
cellation of a sold out trip meant only additional work and

trouble for Ronnie, but as usual, he accepts adversities
philosophically and continues to plan future and better trips

which | trust you will all support. His convention activities are
going to become more evident in the next two days, and | know
that with the effort and dedication he is giving to this conven-
tion, as he has in the past to such functions, we are in fora fine
affair.

To all these chairmen whose committees | have mentioned
_and the other chairmen whose committees were no less impor-
tant, to Bernie Lachman, Stanley Yaffe, Donald Fedder, Dr.
Peter Lamy, Irvin Kamanitz, Dr. Thomas Sisca, and Paul Freiman,
my special gratitude to all of you. Good chairpeople and com-
mittees are the working element of any organization. The de-
gree to which they apply themselves and succeed determines

| the success of the entire body.

The House of Delegates led by Speaker Kamenetz will, | am
sure, devote adequate time to the discussion and possible solu-
tion of some of our problems. The House must function well for
the good of the Association. We were fortunate to have the B.
Olive Cole Pharmacy Museum in the Kelly Memorial Building

_ included in the Bicentennial Campus Tour and we are sharing in
the total campus observance of the Bicentennial Year celebra-
| tion. Join in the Campus Tour, if you can.

We are appreciative of the interest and guidance the Associa-
tion received this year from Dr. William J. Kinnard, Jr., Dean of
the School of Pharmacy. The Dean’s positive and constructive
commentary on pharmacy generally is a great source of infor-
mation and elucidation to us. We are likewise indebted to Joe
Kaufman, counsel to the Association, for his graciousness and
his availability for consultation at all times. | want to thank Joe
for providing critical assessments and sound advice.

JULY, 1976

The changing face of the Maryland State Board of Pharmacy is
another area of supreme importance to the pharmacist. The
introduction of a lay individual and an additional pharmacist to
serve on the Board will, | hope, add strength to the Board’s
actions. It will also, | am sure, help to create better under-
standing, both to the profession and to the public of the many
functions the Board performs.

| arranged meetings this year with executives of the major
Baltimore chain drug corporation and also with the incoming
President of the Maryland Society of Hospital Pharmacists, to try
to bring their respective organizations into closer unity with the
Maryland Pharmaceutical Association. So far, | have not met
with success. | can only hope that these efforts will be pursued
and that common objectives and common dangers will move us
closer together.

| wish to acknowledge the interest and participation of the
Student APhA-MPhA chapter members at our meeting this year.
| hope that they will continue to lend their input to Association
proceedings so that all of us will benefit therefrom.

To LAMPA (the Ladies Auxiliary of the Maryland Pharmaceuti-
cal Association), my sincere thanks for their cooperation and for
the vital role they play in the success of our regionals and
conventions. And to TAMPA (the Travelers Auxiliary of the
Maryland Pharmaceutical Association), my sincere gratitude for
their continuing assistance to the Association and their efforts
to insure the success of our Regional and Annual Meetings.

The things that | believed last year were possible of accom-
plishment were for the most part, done. They were done with
your continued understanding and support. When | look back
to the things that were not done, I see the need for changes and
for revised thinking. | would then like to leave several recom-
mendations to be considered by my successor. (1) Ideally, if
sufficient staff were available, the office should continue to
function fully during the active legislative session from January
to April, as well as throughout the year. (2) Priorities on occasion
must be determined by consultative decision. (3) Our journal,
The Maryland Pharmacist, must be brought to current status to
be of greater value and | am glad steps are now being taken to
see that this is done. | should point out that we do have the
timely, informative MPhA Newsletter under the capable chair-
manship of Mel Rubin. (4) Adequate additional resources and
staff, if needed, should be provided in order to properly imple-
ment these recommendations.

In closing, | wish to express my sincere appreciation for the
opportunity to represent all of you during the past year. It was a
singular honor | shall always remember. | want to express my
gratitude to the officers and members of the Board of Trustees
for their confidence and support, and especially to Paul
Freiman, chairman of the Board, for his incisiveness and can-
dor. lam grateful to Executive Director Gruz for his counsel and
assistance at all times. His is a momentous task. And lastly, but
nearest my heart, my wife, Freda, my critic and booster who has
endured this past year as she has done for so many, many years
without complaint, with missed dinners and frequent changes
in plans, to her my simple, ‘Thank you, dear.”

As with most Presidents, | am sure that no single term in office
of one year is long enough for one to do all the things one
wanted to do. Although | did not succeed in achieving all my
goals, where | succeeded, | am satisfied. Thank You.

MELVIN N. RUBIN

1976-77 President
Maryland
Pharmaceutical Association

Melvin N. Rubin was installed as President of the Maryland
Pharmaceutical Association for 1976-77 at the Association’s 94th
Annual Convention.

A native of East Baltimore and a 1951 graduate of City College,
Mr. Rubin graduated from the University of Maryland School of
Pharmacy in 1955.

After service as a pharmacist in the United States Army from
1956 to 1958, Mr. Rubin was employed by Read’s Drug Stores as
a pharmacist until 1965 when he became a partner in the
Paradise Pharmacy. With his associates, John J. Strauch and
Kenneth Sumida, he operates three pharmacies.

Under his chairmanship, the MPhA Newsletter has developed
into an effective communications service to the membership. In
addition, he served as MPhA Legislative Chairman for 1974-75.

He served as Chairman of the Prescription Insurance Program
Committee (Third Party) which had a large part in publication of
a comprehensive chart of all programs in Maryland. He also
played a leading role in the MPhA liaison activity with State
Medical officials. His involvement in MPhA and BMPA activities

has also included service on the following committees: Me
bership, Finance, Banquet, Convention and Seminars.

In addition to the presidency of the Maryland Pharmaceuticg
Association, Mr. Rubin is an active member of the Americat
Pharmaceutical Association, the American Society of Hospite
Pharmacists, the Maryland Society of Hospital Pharmacists a
the National Association of Retail Druggists. Mr. Rubin serve
as 1974 President of the Baltimore Metropolitan Pharmaceutice
Association and as a Clinical Instructor with the University of
Maryland School of Pharmacy Professional Experience Progra
from 1971 to 1975.

A past Kappa Chapter President of the Alpha Zeta Omega)
pharmaceutical fraternity, Mr. Rubin is a recipient of the organi-|
zation’s Double Star Award for service to the pharmaceutical,
profession. He is a member of the Beth Israel Congregation, ©

Mr. Rubin is married to the former Phyllis Sindler of Balti-)
more. Mr. and Mrs. Rubin have two children.

maryland board
of elnarmeacy|

Pharmacy changes — April, May, June

NEW PHARMACIES

Drugland Prescription Center, Joel Mitnick, President; 6023
Moravia Park Drive, Baltimore, Maryland 21206.

Giant of Maryland #244, J. B. Danzansky, President; 7920 Belai
Road, Baltimore, Maryland 21236.

Colonial Apothecary, Glenn Wilson Nash, President; 1098
Mountain Road, Pasadena, Maryland 21122.
CHANGES OF OWNERSHIP

Winns Pharmacy, Philip Shermak; 2450 E. Fayette St., Baltimore
Maryland 21224.

Kay Cee Drugs, Stanley R. Newhouse; 6110 Old Silver Hill Road
District Heights, Suitland, Maryland 20028.

Park Avenue Pharmacy, Leon Rosen, President; 1535 Park Av:
enue, Baltimore Maryland 21217

Mercers Pharmacy, Donald John Ceccorulli; 243 North Marke
St., Frederick, Maryland 21701

Supersales Pharmacy, Bennett A. Friedman, President; Box 20.
Downtown Gambrills, Maryland 21054.
CLOSED

Cameron Court Pharmacy, 8830 Cameron Court, Silver Spring
Md.

Koldewey’s Pharmacy, 1801 W. Pratt St., Baltimore, Marylan¢
a8 PPLE

Hillendale Prescription Pharmacy, 1717 Taylor Avenue, Balti-
more, Maryland 21234.

*Churchville Pharmacy, 2907 Churchville Road, Churchville
Md. 21028.

*(Presc. & files transferred to Thrift Drugs)

.
THE MARYLAND PHARMACIS:

Tofranil-PM’ Géigy
imipramine

In depression

Daily Dosage Chart

Tofranil-PM”

imipramine pamoate

Initial Dose

Usual Optimum
Response Dose

Starting
Dose

le

FAS. 150
mg. mg.

One capsule
lasts from bedtime
to bedtime.

For Maintenance Therapy

A Full Range to Choose From*

J Udo

150 125 100 Ths)
mg. mg. mg. mg.

*Each capsule contains imipramine pamoate
equivalent to 150, 125, 100 or 75 mg. imipramine
hydrochloride.

Tofranil-PM®
brand of imipramine pamoate

Indications: For the relief of symptoms of depression.
Endogenous depression is more likely to be alleviated
than other depressive states

Contraindications: The concomitant use of monoamine

oxidase inhibiting compounds is contraindicated. Hyper-

pyretic crises or severe convulsive seizures may occur in
patients receiving such combinations. The potentiation of
adverse effects can be serious, or even fatal. When it is
desired to substitute Tofranil-PM, brand of imipramine
pamoate, in patients receiving a monoamine oxidase in-
hibitor, as long an interval should elapse as the clinical
situation will allow, with a minimum of 14 days. Initial
dosage should be low and increases should be gradual
and cautiously prescribed. The drug is contraindicated
during the acute recovery period after a myocardial infarc-
tion. Patients with a known hypersensitivity to this com-
pound should not be given the drug. The possibility of
cross-sensitivity to other dibenzazepine compounds
should be kept in mind.

Warnings: Usage in Pregnancy: Safe use of imipramine

during pregnancy and lactation has not been established;

therefore, in administering the drug to pregnant patients,
nursing mothers, or women of childbearing potential, the
potential benefits must be weighed against the possible
hazards. Animal reproduction studies have yielded incon-
clusive results. There have been clinical reports of con-
genital malformation associated with the use of this drug,
but a causal relationship has not been confirmed.

Extreme caution should be used when this drug is given

to

—patients with cardiovascular disease because of the
possibility of conduction defects, arrhythmias, myocar-
dial infarction, strokes and tachycardia;

—pPpatients with increased intraocular pressure, history of
urinary retention, or history of narrow-angle glaucoma
because of the drug's anticholinergic properties;

—hyperthyroid patients or those on thyroid medication
because of the possibility of cardiovascular toxicity;

—patients with a history of seizure disorder because this
drug has been shown to lower the seizure threshold;

—patients receiving guanethidine or similar agents since
imipramine may block the pharmacologic effects of
these drugs

Since imipramine may impair the mental and/or physical

abilities required for the performance of potentially

hazardous tasks such as operating an automobile or
machinery, the patient should be cautioned accordingly.

Usage in Children: Tofranil-PM, brand of imipramine

pamoate, should not be used in children of any age be-

cause of the increased potential for acute overdosage
due to the high unit potency (75 mg., 100 mg., 125 mg.
and 150 mg.). Each capsule contains imipramine

pamoate equivalent to 75 mg., 100 mg., 125 mg. or 150

mg. imipramine hydrochloride

Precautions: |t should be kept in mind that the possibility

of suicide in seriously depressed patients Is inherent in
the illness and may persist until significant remission oc-
curs. Such patients should be carefully supervised during
the early phase of treatment with Tofranil-PM, brand of
imipramine pamoate, and may require hospitalization.
Prescriptions should be written for the smallest amount
feasible.

Hypomanic or manic episodes may occur, particularly in
patients with cyclic disorders. Such reactions may neces-
sitate discontinuation of the drug. If needed, Tofranil-PM,
brand of imipramine pamoate, may be resumed in lower
dosage when these episodes are relieved. Administration
of a tranquilizer may be useful in controlling such
episodes.

Prior to elective surgery, imipramine should be discon-
tinued for as long as the Clinical situation will allow.

An activation of the psychosis may occasionally be ob-
served in schizophrenic patients and may require reduc-
tion of dosage and the addition of a phenothiazine.

In occasional susceptible patients or in those receiving
anticholinergic drugs (including antiparkinsonism agents)
in addition, the atropine-like effects may become more
pronounced (e.g., paralytic ileus). Close supervision and
careful adjustment of dosage is required when this drug is
administered concomitantly with anticholinergic or sym-
pathomimetic drugs.

Avoid the use of preparations, such as decongestants
and local anesthetics, which contain any sympathomime-
tic amine (e.g., adrenalin, noradrenalin), since it has been
reported that tricyclic antidepressants can potentiate the
effects of catecholamines.

Patients should be warned that the concomitant use of
alcoholic beverages may be associated with exaggerated
effects.

Both elevation and lowering of blood sugar levels have
been reported.

Concurrent administration of imipramine with electroshock
therapy may increase the hazards; such treatment should
be limited to those patients for whom it is essential, since
there is limited clinical experience.

Adverse Reactions: Note: Although the listing which fol-
lows includes a few adverse reactions which have not
been reported with this specific drug, the pharmacological
similarities among the tricyclic antidepressant drugs re-
quire that each of the reactions be considered when imip-
ramine is administered.

Cardiovascular: Hypotension, hypertension, tachycardia,
palpitation, myocardial infarction, arrhythmias, heart block,
stroke, falls.

Psychiatric: Confusional states (especially in the elderly)
with hallucinations, disorientation, delusions; anxiety,
restlessness, agitation; insomnia and nightmares;
hypomania; exacerbation of psychosis.

Neurological: Numbness, tingling, paresthesias of ex-
tremities; incoordination, ataxia, tremors; peripheral
neuropathy; extrapyramidal symptoms; seizures, altera-
tions in EEG patterns; tinnitus.

Anticholinergic: Dry mouth, and, rarely, associated sub-
lingual adenitis; blurred vision, disturbances of accommo-
dation, mydriasis; constipation, paralytic ileus; urinary re-
tention, delayed micturition, dilation of the urinary tract.
Allergic: Skin rash, petechiae, urticaria, itching, photosen-

sitization (avoid excessive exposure to sunlight); edema
(general or of face and tongue); drug fever; cross-
sensitivity with desipramine.

Hematologic: Bone marrow depression including agran-
ulocytosis; eosinophilia; purpura; thrombocytopenia.
Leukocyte and differential counts should be performed in
any patient who develops fever and sore throat during
therapy; the drug should be discontinued if there is evi-
dence of pathological neutrophil depression.
Gastrointestinal: Nausea and vomiting, anorexia, epigas-
tric distress, diarrhea; peculiar taste, stomatitis, abdominal
cramps, black tongue.

Endocrine: Gynecomastia in the male; breast enlarge-
ment and galactorrhea in the female; increased or de-
creased libido, impotence; testicular swelling; elevation or
depression of blood sugar levels.

Other: Jaundice (simulating obstructive); altered liver
function; weight gain or loss; perspiration; flushing; uri-
nary frequency; drowsiness, dizziness, weakness and
fatigue; headache; parotid swelling; alopecia.

Withdrawal Symptoms: Though not indicative of addiction,
abrupt cessation of treatment after prolonged therapy
may produce nausea, headache and malaise.

Dosage and Administration: |n adult outpatients,
therapy should be initiated on a once-a-day basis with 75
mg./day. This may be increased to 150 mg./day which is
the dose level which usually obtains optimum response. If
necessary, dosage may be increased to 200 mg/day.
Dosage should be modified as necessary by clinical re-
sponse and any evidence of intolerance. Daily dosage
may be given at bedtime, or in some patients in divided
daily doses.

Hospitalized patients should be started on a once-a-day
basis with 100-150 mg./day and may be increased to 200
mg./day. Dosage should be increased to 250-300 mg./day
if there is no response after two weeks.

Following remission, maintenance medication may be re-
quired for a longer period of time at the lowest dose that
will maintain remission. The usual adult maintenance
dosage is 75-150 mg./day on a once-a-day basis, prefer-
ably at bedtime.

In adolescent and geriatric patients, capsules of Tofranil-
PM, brand of imipramine pamoate, may be used when
total daily dosage is established at 75 mg. or higher. It is
generally unnecessary to exceed 100 mg./day in these
patients. This dosage may be given once a day at bed-
time or, if needed, in divided daily doses.

How Supplied: Tofranil-PM, brand of imipramine
pamoate: Capsules of 75, 100, 125 and 150 mg. (Each
capsule contains imipramine pamoate equivalent to 75,
100, 125 or 150 mg. of imipramine hydrochloride.)

(B) 98-146-840-A(9/75) 667120

For complete details, including dosage and adminis-
tration, please refer to the full prescribing informa-
tion.

GEIGY Pharmaceuticals
Division of CIBA-GEIGY Corporation
Ardsley, New York 10502

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DRUG EVALUATION

Nitroglycerin Ointment 2%

James Quinlan, M.D.*
Ralph Shangraw, Ph.D. **

EVALUATION

The organic nitrates have the property of relaxing smooth
muscle. In the cardiovascular system, the post capillary venules
sensitive to gravity are especially affected by organic nitrates.
Dilation results in pooling in the venules, a fallin venous return,
a fallin stroke volume, and a fall in systolic pressure. All of these
contribute to a reduction in myocardial oxygen requirements.

Sublingual nitrates have been used because of these desira-
ble effects but the major shortcoming is a short duration of
action. Nitroglycerin ointment (2%) has been demonstrated as a
useful adjunct to therapy in patients with disabling angina.
Davis (1) described the benefits as long ago as 1953, but his was
an uncontrolled study. Attia did a controlled study in 1972 (2),
with 11 of 15 patients showing marked improvement — i.e.
requiring less than half the usual dose of Tng. per day. Reicheck
demonstrated a three hour duration of improved exercise toler-
ance accompanied by a longer fall in the blood pressure, which
also lasted for three hours (3). This was markedly better than
what sublingual nitroglycerin or isosorbide could produce.
Controlled clinical and physiological studies indicate that the
2% nitroglycerin ointment is effective in reducing the frequency
of angina attacks.

It is also known that nitroglycerin can normalize depressed
left ventricle function in response to exercise in patients with
coronary artery disease without angina (4). Johnson demon-
strated that sublingual nitroglycerin produced a prompt fall in
the pulmonary artery hypertension associated with left ven-
tricular failure and paroxysmal nocturnal dyspnea (5). Clinical
improvement accompanied the objective improvement.

Thus, the effectiveness of organic nitrates in relief of angina
pectoris or congestive failure is documented. The prolonged
effectiveness of 2% nitroglycerin ointment has also been noted.
The disturbing point is how one can effectively correlate a
clinical response to an imprecise dose. The actual dose ab-
sorbed depends upon the amount of ointment, the surfact area,
the degree of spreading, the thickness of the ointment, etc.
(See below). In summary it is concluded that 2% nitroglycerin is
effective for prolonged relief of angina pectoris both by subjec-
tive and objective criteria.

METHOD OF APPLICATION

Nitroglycerin ointment is a topical product containing 2%
glyceryl trinitrate in a vehicle of lanolin and white petrolatum.
The product is unique in that it is the only ointment applied
topically in which the specific objective is to obtain systemic
drug action. Although there is good clinical evidence that the
product is effective, it is of utmost importance that a reproduci-
ble protocol be set up for its application.

1. Nitroglycerin ointment is measured in terms of inches of
the ribbon extruded from the tube. The usual dose is a1to2
inch ribbon applied 3 or 4 times daily. The optimum dose is

JULY, 1976

determined by starting with a one inch application and
increasing the dose ‘2 inch at a time until headache occurs
and then decreasing to the largest dose which does not
cause a headache.

CAREFUL TITRATION OF THE PATIENT IS IMPORTANT.

2. Nitroglycerin ointment is applied over a5 to 8inch diameter
area on the body. Site of application is commonly the chest
but other areas of the body such as the leg can be used. The
size of the area of application should be kept constant. Site
of application should also be kept constant. If it is necessary
to change site, it should be remembered that percutaneous
absorption may change from one area to another. Although
the chest is the most common site of application, there is no
direct action on the heart.

3. Nitroglycerin ointment is usually applied in a thin uniform
layer to the skin. The amount of rubbing will affect the rate
and duration of clinical response. The measuring applicator
is usually used to spread the ointment. If it is not used,
absorption can occur through skin of the hand.

4. Aplastic wrap covering is often used to protect clothing and
prevent loss of ointment. The occlusiveness of the protec-
tive covering plays a very important role in percutaneous
absorption and will alter dose requirements.

SUMMARY

In order to obtain maximum reproducibility of clinical re-
sponse, it is important to keep the following factors constant:

1. Amount of Ointment

2. Area of Application

3. Site of Application (If possible)
4. Amount of Rubbing

5. Presence of Occlusive Bandage
6. Nature of Occlusive Bandage
REFERENCES

1. Davis, J. A. and Weisel, B. H. Am. J. Med. Sci. 230: 259-263, 1955.
2. Attia, M., Cardiol. Dig. 7: 9-12, September 1972.

3. Reichek, N. et al. Circulation 50: 348-352, (August) 1974.

4. Goodman and Gilman. The Pharmacological Basis of Therapeutics.
5. Johnson). Bs etralaiN- BM. 2572 1114-1117, 1957.

“Assistant Professor of Clinical Pharmacy, University of Maryland
School of Pharmacy.

**Professor and Chairman of the Department of Pharmacy, University
of Maryland School of Pharmacy.

13

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School of Pharmacy

Honors Convocation

Honors Convocation for the 1976 graduates of the School of
Pharmacy, University of Maryland at Baltimore was held on
Thursday, June 3.

Guest speaker for the event was Vincent R. Gardner, chief,
Drug Studies Branch, Office of Research and Statistics, Social
Security Administration, Washington, D. C.

Awards were presented by Dr. Ralph Shangraw, Professor
and Chairman of the Department of Pharmacy.

Gold Medal for General Excellence: Carla Ann Mosser,

Kitzmiller.

Certificates of Honor to holders of next highest averages:
Paula Dawn Wolfe, Parkton; Karen Beth Demsky, Balti-
more; Leslie Ann Silverberg, Baltimore.

L. S. Williams Practical Pharmacy Prize, to the senior student
having the highest general average throughout the course
in practical and dispensing pharmacy: Carla Ann Mosser,
Kitzmiller.

Andrew G. DuMez Medal, for superior proficiency in phar-
macy: Karen Beth Demsky, Baltimore.

Conrad L. Wich Pharmacognosy Prize, for exceptional work
throughout the course in pharmacognosy: Paula Dawn
Wolfe, Parkton.

Dr. and Mrs. Frank J. Slama Award, for superior work in the
newer areas of pharmacognosy: Gary Allan Merica, Balti-
more.

William Simon Memorial Prize, for superior work in the field
of practical and analytical chemistry: Carla Ann Mosser,
Kitzmiller.

Wagner Pharmaceutical Jurisprudence Prize, for meritorious
academic achievement in pharmaceutical jurisprudence:
Louis Silverstein, Havre de Grace.

John F. Wannenwetsch Memorial Prize, to a senior student
majoring in general pharmacy who has exhibited excep-
tional performance and promise in the practice of commu-
nity pharmacy: Richard Noll Fry, Greenbelt.

Kappa Chapter, Alpha Zeta Omega Fraternity Prize, to a
senior student for proficiency in pharmacology: Vincent
Lee Fabiano, Rockville.

Epsilon Alumnae Chapter, Lambda Kappa Sigma—Cole Award,
to a senior student for proficiency in pharmacy administra-
tion: Dorothy Anne Boucher, Abingdon, Va.

Maryland Society of Hospital Pharmacists Award, to a senior
student who shows promise in the area of hospital phar-
macy: Sherry Lynn Williams, Baltimore.

The Frank J. Slama Award, by the school’s Alumni Association
to a graduating student who has excelled in extra-curricular
activities: Alex Maurice Taylor, Baltimore.

Also announced at the senior honors convocation were those

students eligible for honors and high honors.

High Honors: Carla A. Mosser, Kitzmiller; Paula D. Wolfe,
Parkton; Karen B. Demsky, Baltimore; Leslie A. Silverberg,
Baltimore; Joanne L. Travis, Wilmington, Del.; Lily L. Chua,

JULY, 1976

calendar

September 9 (Thursday) — Maryland Society of Hospital Phar-
macists, Johns Hopkins, 7:30 P.M.

September 10 (Friday) — Baltimore Veteran Druggists Associa-
tion 50th Anniversary Luncheon, Broadview (Victorian
Room)

September 15 (Wednesday) — Upper Bay Pharmaceutical Asso-
ciation Meeting, The Bush River Yacht Club, 10:15 P.M.

September 19-23 (Sunday, Monday, Tuesday, Wednesday,
Thursday) — NARD Convention, San Francisco

September 28 (Tuesday) — Baltimore Metropolitan Pharmaceu-
tical Association Meeting, Quality Court, Pikesville, 8:30
P.M.

October 14 (Thursday) — MPhA Fall Regional and House of
Delegates Meeting

November 4 (Thursday) — MPhA Simon Solomon Pharmacy
Economics Seminar

November 17 (Wednesday) — Upper Bay Pharmaceutical Asso-
ciation Meeting

November 18 (Thursday) — Baltimore Metropolitan Phar-
maceutical Association Annual Meeting

1977

January 14-21 — MPhA Seminar and Tour — Acapulco and
Mexico City

February 13 (Sunday) — BMPA Annual Banquet, Bluecrest
March 5-13 — MPhA Trip to Vail, Colorado

April 21 (Thursday) — MPhA Spring Regional and House of
Delegates Meeting

Bethesda; Stephen S. Navran, Baltimore; and Linda C.
Houchin, Laurel.

Honors: Gary A. Merica, Baltimore; George Groleau, Balti-
more; Joseph Fallon, Lawrenceville, N. J.; John Gregory,
Rockville; Vincent Fabiano, Wheaton; Dorothy Boucher,
Abingdon, Va.; and Louis Silverstein, Havre de Grace.

This year’s new members of Rho Chi:

Graduate Students: Michael F. Powell, Raymond L. Sapssil,
Marc R. Summerfeld.

Fifth-Year Students: Dorothy A. Boucher, Vincent L. Fabiano,
Paul F. Jarosinski, Stephen S. Navran, Louis Silverstein.
Fourth-Year Students: Carla J. Beckmann, Michelle K. Broll,

Margaret C. Brophy, Thomas F. Carroll, Terri F. Clayman,
James M. Easom, Irene M. Georgiou, Bonnie Levin, Shar-
mon M. Remmers, James W. Rhodes, Cathie L. Schumaker,

Robert H. Schumaker, Paul J. Vitale, Mary Young.

15

The Colonial and Revolutionary Heritage
of Pharmacy in America

by David L. Cowen*

INTRODUCTION

American pharmacy, in every tacet of its origins and de-
velopment, reflected the same social, political, and economic
forces that moulded our nation. Its origins are part of the impe-
rial motivations that led to discovery, exploration, and settle-
ment; its early development — or lack of it —— demonstrated the
effect of frontier conditions on American life and institutions;
its failure to attain a separate identity until well into the 19th
century reflected both the British heritage of liberty and
laissez-faire, and the relatively backward state of world science.
Structurally, in 19th century America, American pharmacy was
to reflect the federal system of government. Professionally, the
progress of science, technology, and industrialization were to
change pharmacy from an art into a science, with tremendous, if
as yet undetermined, consequences for the present and future
practice of pharmacy.

The history of pharmacy, thus, is the history of our country in
microcosm. Whether it is in exploration and settlement, the
Revolution, the new nationhood, Jacksonian democracy, slav-
ery, industrialization, large-scale business enterprise, the Pro-
gressive Movement, or depressions great and small, pharmacy
was a part of the whole drama. One could draw meaningful
illustrations in writing a history of our country from the history
of pharmacy: what more poignant statement of the condition of
the American Revolutionary Army and the emotions stirred up
by the war than that on the title page of the Lititz Pharmacopiea
(1778) which lamented that it was “especially adapted to our
present poverty and straitened circumstances due to the fero-
cious inhumanity of the enemy, and the cruel war unexpectedly
brought upon our fatherland’?

Itis hoped that this series of articles, helping to celebrate our
Bicentennial to be sure, will point up the fact that pharmacy is an
integral part of the American scene, that it did not develop in
vacuo, and that as it examines its past and looks into the future,
pharmacy will continue to recognize its intimate relationship to
American history and American social developments.

Drugs, Empire and Trade

It may seem strange to start the history of Pharmacy in British
North America with names like Richard Hakluyt and Sir Walter
Raleigh, but itis strange only because school books have taught
that the British sea hawks and merchant adventurers sought first
gold and silver, and later tobacco, indigo and naval stores, and
neglect to emphasize the importance of drugs and spices in the
plans and expectations of the sea captains. Drugs and spices, it
needs to be remembered, played a decisive role in the discov-

David L. Cowen is Professor of History at Rutgers, the State University of
New Jersey.

Reprinted with permission of the author and The New Jersey Journal of
Pharmacy.

16

ery of the New World; it was to be expected that interest in then
was to continue into the age of exploration and settlement. —

Hakluyt, writing in his Discourse of Western Planting, pro |
pounded strategic and economic arguments for establishing ar
English colony on the Virginia coast. His economic argument:
were a Classic exposition of mercantilistic colonialism, and con. |
spicuous among the products which the mother country coulc
expect to procure in the New colony were ‘‘dyes and drugs.” Ir_
1585 he placed men “‘skilful in all kinds of drugs’ second only te |
men “skilful in mineral causes” in the list of 31 sorts of men he
wanted for a forthcoming expedition.

The interest in drugs and spices — expressed even earlie)
(1576) by Sir Humphrey Gilbert — was directed principally to.
ward medicinal plants. The British explorers of the Atlantic
seaboard — Hawkins, Barlowe, Brereton, Pring, Rosier, and
Hariot, to name some of them — all made reference in their
reports to the medicinal plants they encountered. The promo-
tional literature that emanated from sea captains, Lords Pro-.
prietors, and chartered companies all stressed the abundance
and availability of medicinal plants. Sometimes the oppor-
tunities for profit were pointed up, as when the Virginia Com-
pany emphasized the high market value of drugs to be found in
the colony (1610); sometimes the stress was placed on the.
health potential of the drugs, as in the long list of drugs in John
Josselyn’s New England Rarities Discovered (1672). Captain John
Smith, William Penn and General George Oglethorpe all made
attractive references to medicinal plants in their accounts: in-
deed there was undoubtedly a good deal of puffery in their
glowing propaganda. As a Pennsylvania booster wrote at the
end of the 17th century:

A plentiful Land, O plentiful indeed,

For Plants, and Roots and Herbs.

Despite the exaggeration, however, the mother country did
find the colonies a source of drugs, and a trade in drugs de-
veloped almost immediately. In 1602 one of Sir Walter Raleigh’s
ships returned with a cargo of timber and sassafras, china root,
benjamin, sarsaparilla, cassia lignea, and an unknown “strong
bark.” These had been obtained by trading with the Indians in
the vicinity of Cape Fear.

Of these plants sassafras was, and was to remain, the most
important. Although the French had made note of the sassafras
root as early as 1562-1564, it gained popularity in Europe quickly
only after Monardes described it in 1574. Thomas Hariot, as-
tronomer, mathematician, and man of learning who was re-
sponsible for the navigational planning of Raleigh’s expeditions
and who was himself a visitor to America in 1585, proclaimed
Sassafras a ‘sovereign remedy” possessing ‘many virtues.” It
was esteemed in ‘‘the French Poxe... the Plague, and many
other Maladies.”

THE MARYLAND PHARMACIST

THE
M OD E L

OF THE

GOVERNMENT

Of the

PROVINCE
EAST:NEW- JERSEY

AMERICA

And Encouragemen's tor fuch as Defigns
to Le concerned there.

Publiftocd for Information of fuch » are de-
firous to be Interc'ted in that place.

TeDeIENe Be Up ReG) Hy,

Printed by Joba Reid, And Sold be
Alexander O2fton Scationcr in the
Parliament Clojs. Anno
DOM. 1635.

Title page of a pamphlet seeking to entice settlers to New Jersey where,
it said, “are an abundance of curious Herbs, Shrubs, and Trees; and no
doubt Medicinall ones for making of drugs.”

JULY, 1976

In fact, sassafras gained so phenomenal a reputation that
Raleigh found it very profitable — in 1602 he reported that he
was Selling the product at from L1,000 to L2,000 aton. Indeed the
gains were so great that Raleigh had to fight off poachers on the
monopoly rights he had been given, and investors were readily
attracted to support expeditions if sassafras was a prospect. The
Jamestown colony almost foundered because seamen and
settlers alike stampeded into what must be called a sassafras
rush. The sailors were said to have lost and ruined many tools
and the colonists were said to be neglecting their cornfields in
their eagerness to gather sassafras.

The price of sassafras fell precipitously after the establish-
ment of Jamestown, and in 1620 Sir Edwin Sandys, head of the
Virginia Company, reported that it was worth very little and
recommended the control and curtailment of production. Yet
the drug’s medicinal reputation persisted and the promotional
literature continued to point out the availability of the sassafras
tree — in Maryland, New Jersey, and Georgia, for example. It
continued to be exported throughout the colonial period andin
1770 alone England imported 76% tons of sassafras, worth
12,142, from America.

The trade in sassafras brought with it two incidents, which,
though admittedly tangential to our theme, are significant in
terms of the events that were to take place some 150 years later
and that we are commemorating. One concerned the attempt,
in 1621, to gain exemption for poorer grades of sassafras (and of
tobacco and sarsaparilla also) from the tariff when intended for
re-export from England. The other, in the same year, involved
the refusal of planters in Virginia to comply with a levy by
Governor Wyatt, at the behest of the Company, of 66 Ibs. of
sassafras per man. The Governor insisted that the planters acted
‘out of contempt for authority.’ The problems that rocked the
empire in the 1770's had had a long history!

During the colonial period supplies of other drugs than sas-
safras were to be exported from the American provinces. These
included snakeroot, ipecacuanha, pink root, sarsaparilla, jalap,
ginseng, sumach, tumeric, and castoreum (the last from beaver
‘“‘codds”’), among others. At the eve of the Revolution, in 1770,
trade statistics indicated that the four most important of these at
the time — castoreum, ginseng, snakeroot, and sassafras — had
an export value of L5,142. That other parts of Britain’s American
empire had become more significant in this connection is evi-
dent from the fact that the total value of cortex eleutheria
(cascarilla), cortex winteranus, and lignum vitae — that came
from the West Indies and elsewhere — was about three and a
half times as great, 118,225. The expectations of the mother
country with regard to drugs were perhaps greater than the
realization, but Britain did not fail to exploit the potential of the
flora and fauna of its overseas colonies.

(WE

EARLY PHARMACY IN BALTIMORE

By B. F. Allen Ph.D.
Associate Professor of Pharmacy
University of Maryland School of Pharmacy

Founded in 1729, Baltimore Town expanded very slowly until
1750 when a combination of farm products (wheat and tobacco)
and better roads caused the Patapsco River Basin to come alive
and assure Baltimore’s growth as a mercantile center.'

Christened Baltimore Town in honor of Charles Calvert, fifth
Lord Baltimore,? the town in 1729 had about a dozen houses and
a population of about a hundred persons. The location along
the Patapsco River gave it easy access to the Chesapeake Bay.

In two decades the population increased to 3,500 with 350
houses and ten physicians who provided medicine in connec-
tion with their practice.* The town boundaries at this time cov-
ered approximately eighty-eight acres.

The first drug store was established by Dr. William Lyon in
1746 at Market (now called Baltimore) and Calvert streets.‘ It is
said that Dr. Lyon was a practical man, without education, but
with talent and the first “real” pharmacist in Baltimore. He was
active in civic affairs, commanded much respect and took active
measures to better the public health of the town.* Some years
later, Dr. Lyon formed a partnership with a Mr. Walker. How-
ever, the firm was dissolved in 1772 and Dr. Lyon devoted all of
his time to the practice of medicine.

The second drug store appears to have been established by
Dr. Alexander Stenhouse in 1764 on Market Street. He studied
medicine and pharmacy in Edinburgh and practiced in London
before coming to Baltimore. His political ties to the Royalist
Party caused the “Committee of Safety” to confiscate his stock
of drugs. This forced his flight to Philadelphia and eventual
return to England.

The third drug store was established by Dr. John Boyd in 1767
(location not identified). He was from the New England area and
educated at Princeton (M.A. degree). He was probably the first
in Baltimore to call himself a druggist and his place of business a
‘medical store’. In 1775, Dr. Boyd was a member of the ‘“‘Com-
mittee of Safety’’ and called upon the ladies of the town,
through the newspapers, for lint and bandages for the troops.
(Dr. John Boyd is buried in the Westminster graveyard, south-
east corner Fayette and Greene Streets).

During this period of time it appears that practically all of the
drug stores were operated by medical practitioners since the
individuals involved were always referred to as ‘doctor’. Some
of these were: Dr. Patrick Kennedy (1773) at the lower end of
Market Street near the bridge (probably, today at Fallsway); Dr.
Labesius (1778) at St. Paul’s Lane; Dr. Andrew Aitken (1783) in
the Fell’s Point area; Dr. J. Tyler (1787) on Market Street and Dr.
Anthony Mann (1789) on the northeast corner of Market and
Calvert Streets. Dr. Mann’s apothecary shop or drug store was
named the ‘Golden Mortar’.

Baltimore received its first impressions in higher pharmacy
from France and from French refugees.” The interest which that
country took in the American Revolution seemed to stimulate
young pharmacists to risk their fortunes upon American soil.

18

From among these and Acadian exiles, Baltimore was furnished |

with several reputable apothecaries. (Acadia: An early name for
Nova Scotia).

In 1791, because of Napoleon and other European troubles,
some French refugees from the mother country and colonies in
the West Indies settled in the Baltimore area now known as
Seton Hill (500 block North Paca Street).®

In 1793, many persons fleeing from the revolution and mas-
sacre of Santo Domingo took refuge in the city; thus, swelling
its population to about fifteen thousand. Among these came
one progressive pharmacist of rare ability and knowledge in the
character of Monsieur Edme Ducatel.?

Of the Santo Domingo refugees of 1793, young Edme (Ed-
mund) Ducatel happened to be a well-trained pharmacist who
had attended the Ecole de Paris. In 1796, he established himself
in business as achemist and druggist at 26 West Baltimore Street
(old number), third door west of Harrison Street. At this loca-
tion, through scientific methods and ethical practices, he held
for almost 40 years the unabated confidence of physicians and

patrons, thereby giving to pharmacy in Baltimore its true birth,

he being its “real’’ father.

Edme Ducatel was of small stature, dark complexion, quick in
movement and speech (French) and usually was observed with
some sort of flower between his lips (so moisture could be
supplied). He was an experienced botanist — a man most help-
ful to the sons of fellow refugees and to many other deserving
young men who sought positions in his store. Many later be-
came physicians or self-established pharmacists who brought
professional and commercial dignity to their several com-
munities. (Therefore, in addition to his drug store activities, Mr.
Ducatel was a pioneer pharmacy preceptor).

By admitting a son as a partner in 1818, the firm’s name
became ‘‘Edme Ducatel and Son” and shortly thereafter, a sec-
ond son made it ““Edme Ducatel and Sons”.

Edme (also known as Edouard) Ducatel died around 1834 and
this also ended the reputable business established on Baltimore
Street. His early and consistent endeavor in behalf of profes-
sional retail pharmacy was recognized by his contemporaries as
well as by posterity which has given him the title: ‘‘The Father of
Baltimore Pharmacy’’. (Chartered as a city in 1799, Baltimore by
1814 had a population of nearly 50,000. It was the third largest
city in America and its leaders frankly dreamed of becoming
number one)."°

John Michel LaRoque (1788-1864) was five years old when the
LaRoque family escaped the Santo Domingo insurrection and
reached Baltimore in 1793. After going through the city paro-
chial schools he was accepted in Ducatel’s store where he
remained for some years, becoming thoroughly equipped in
the science and art of pharmacy. In 1817, he established his own
business at 20 West Baltimore Street, third door east of
Ducatel’s and at once entered into the manufacture of proprie-

THE MARYLAND PHARMACIST

_tary medicines. Two years later, the firm became ‘‘LaRoque and
Milhau” and continued until 1827, when Mr. Milhau withdrew
and moved to New York. LaRoque’s son, John Phillip Emile
(1820-71) succeeded to the business, which passed into the
_ hands of strangers after his death and out of existence after the
“Great Baltimore Fire’ of 1904.

John F. Milhau (1795-1874) was born in Baltimore in 1795. His
family was also among the Santo Domingo refugees who
reached Baltimore that year. After elementary training in paro-
chial and city schools, he was sent to the Emmitsburg Seminary
(the seedling of Mount Saint Mary’s College’? which is located
near Emmitsburg, Maryland in the northern part of the state on
one of the routes to Gettysburg).

From the seminary he entered Ducatel’s drug store where he
practiced for several years and then in 1816 established his own
store at 3 West Baltimore Street. In 1819, he abandoned this
location and became a partner of Mr. LaRoque. After Mr. Milhau
_withdrew from the partnership, he spent several years in
_ foreign study and travel. He then established on Broadway and
Maiden Lane (New York City) a business, much after the lines of
his former Baltimore connection, and in due time acquired an
enviable name and trade.

In New York, John Milhau conducted, from 1830-1869, one of
the best-known representatives of the older American profes-
sional pharmacies. He was one of the early leaders of the New
York College of Pharmacy. The passage of a U. S. Drug Law in
1848 requiring the observance of certain standards (purity,
strength, etc.) was due mainly to his persistent and conscien-
tious efforts."

Nicholas Monsarrat, a refugee of 1793, also obtained his train-
ing at Ducatel’s. In 1819 he became apothecary to the Baltimore
General Dispensary. Several years later he established his own

_ drug store on West Baltimore Street (north side) near Light. His
business was conducted under very rigid discipline and exact-
_ing methods.

Oscar Monsarrat (1813-1887) was a cousin of Nicholas Mon-

sarrat and was literally brought up in his cousin’s drug store. He

_ remained in the retail drug business for 60 years and at one time

Operated a store at 113 South Broadway.'® His pharmacy was

most unpretentious with a stock consisting of simply drugs,

without the slightest innovation of side-lines. (Note: Monsarrat
was also sometimes spelled Monsurat and Monsurratt).

Elias Durand (1793-1873) was a native of France who served in
her army under Napoleon. He emigrated to this country, locat-
ing first in New York, then Philadelphia, next Baltimore and
finally Philadelphia.’”? While in Baltimore, he was employed at
Ducatel’s which was the only “real drug store” in the city, in the
eyes of Frenchmen and many other citizens. Durand was not
only a fine chemist but an unusual botanist; he devoted much
time and study to botany, especially to the classification of
indigenous plants.

He established a drug store in Philadelphia in 1825 and oper-
ated the first soda fountain in an American pharmacy."®
Durand’s store had much to do with the introduction of scien-
tific pharmacy into Philadelphia. The most important part of the
pharmacy was the stock of drugs, chemicals and the apparatus
for making ‘carbonic acid water’. In 1835 Durand was the first
to introduce the bottling of mineral waters in this country.

JULY, 1976

Another store of this early period was founded in 1824 by Mr.
Thomas G. MacKenzie (1802-1873), northeast corner of Balti-
more and Gay Streets.'? After a year the firm’s name was
changed to ‘Thomas G. MacKenzie and Company”, and in 1827,
at the death of his father, Dr. Colin MacKenzie (1775-1827), it
was changed again to ‘MacKenzie and Company,” inasmuch as
his two brothers, prominent physicians with a following, had a
monetary interest.

Thomas G. MacKenzie was the great moving spirit in estab-
lishing the Maryland College of Pharmacy. He was one of the
organizers (1840) as well as one of the incorporators (1841) of the
college.*° The lectures at the new institution were given at the
back of the store in his little office which was not larger than the
hall of ahome. In the absence of the regular lecturers, MacKen-
zie gave occasional talks.*' The college functioned at this loca-
tion during the period of 1840-44 and so monopolized all avail-
able space as to interfere seriously with other business uses.
The first class (1840) consisted of six young men, one being Mr.
LaRoque’s son, Emile, who did not come up for graduation
(1842). However, three men did and were successful (Frederick
A. Cochrane, Alpheus P. Sharp, and William S. Thompson??).

George W. Andrews (1801-77) established a drug store in 1829
at 3 West Baltimore Street diagonally across from LaRoque’s. He
stressed these principles: ‘English and French chemicals, fresh
and choice; test-reagents prepared to order; drugs and
medicines, etc.’’ He soon became a chemist of repute as well as
a prescriptionist who enjoyed the implicit confidence of physi-
cians and the public.?? He was also one of the incorporators of
the Maryland College of Pharmacy and its president for many
years (1844-71).7* Mr. Andrews grave is in the old Westminster
Church graveyard.*°

Notes and References

. Maryland Historical Magazine, 69 (1974) 342-360.

2. Fred Kline, “Baltimore: The Hidden City’’, National Geographic, 147
(1975) 197.

3. B. Oliver Cole, “Notes on Early Pharmacy in Maryland”, Maryland
Pharmacist, 35 (1960) 676-680.

4. John R. Quinan, ‘The Medical Annuals of Baltimore’ (1808-1880) p.
12:

5. Anon., ‘Persons Who Have Influenced Pharmacy in Maryland”,

Pharmaceutical Seminar (course paper) School of Pharmacy Univer-

sity of Maryland, no date (ca. 1960).

—_—

6. Robert J. Kokoski, ‘“A Review of the Earlier History of Pharmacy in
Baltimore’, Pharmaceutical Seminar (course paper) School of
Pharmacy, University of Maryland, October 29, 1957.

7. Annual Catalogue of the Maryland College of Pharmacy (Session
1891-92), 9.

8. The June 10, 1969 issue of the Baltimore Sunpapers.

9. David M. R. Culbreth, ‘Reminiscences of Early Pharmacy in Balti-
more”, J. Amer. Pharm. Assoc., 17 (1928) 1212-13.

10. Frank A. Cassell, ‘The Great Baltimore Riot of 1812’, Maryland
Historical Magazine, 70 (1975) 241.

11. Reference 9, pp. 1213-1214.
12. Ibid.

13. Bernard C. Steiner, ‘History of Education in Maryland’, Govern-
ment Printing Office, Washington, 1894, pp. 161, 275.

14. Edward Kremers and George Urdang, “History of Pharmacy’, 2nd
Ed., J. B. Lippincott Co., Philadelphia, Pa., 1951, pp. 261, 418, 561.

15. Reference 9, p. 1214.
(Continued on page 36)

19

Testing in Humans:
Who,Where & When.

the weight of ethical opinion:

Few would disagree that the effective-
ness and safety of any therapeutic agent
or device must be determined through
clinical research.

But now the practice of clinical re-
search is under appraisal by Congress, the
press and the general public. Who shall
administer it? On whom are the products
to be tested? Under what circumstances?
And how shall results be evaluated and
utilized?

The Pharmaceutical Manufacturers
Association represents firms that are sig-
nificantly engaged in the discovery and
development of new medicines, medical
devices and diagnostic products. Clinical
research is essential to their efforts. Con-
sequently, PMA formulated positions
which it submitted on July 11, 1975, to
the Subcommittee on Health of the Sen-
ate Labor and Public Welfare Committee,
as its official policy recommendations.
Here are the essentials of PMA’s current
thinking in this vital area,

1. PMA supports the mandate and
mission of the National Commission for
the Protection of Human Subjects of
Biomedical and Behavioral Research and
offers to establish a special committee
composed of experts of appropriate
disciplines familiar with the industry's
research methodology to volunteer its
service to the Commission.

2.PMA supports the formation of an
independent, expert, broadly based and
representative panel to assess the current
state of drug innovation and the impact
upon it of existing laws, regulations and
procedures.

3. When FDA proposes regulations,
it should prepare and publish in the Fed-
eral Register a detailed statement assess-
ing the impact of those regulations on
drug and device innovation.

4.PMA proposes that an appropri-
ately qualified medical organization be
encouraged to undertake a comprehen-
sive study of the optimum roles and
responsibilities of the sponsor and physi-
cian when company-sponsored clinical
research is performed by independent
Clinical investigators.

§. PMA recognizes that the physician-
investigator has, and should have, the
ultimate responsibility for deciding the
substance and form of the informed con-
sent to be obtained. However, PMA
recommends that the sponsor of the ex-
periment aid the investigator in dis-
charging this important responsibility by
providing (1) adocument detailing the
investigator's responsibilities under FDA
regulations with regard to patient consent,
and (2) a written description of the
relevant facts about the investigational,
item to be studied, in comprehensible
lay language.

6. In the case of children, the sponsor
must require that informed consent be
obtained from a legally appropriate rep-
resentative of the participant. Voluntary
consent of an older child, who may be
capable of understanding, in addition to
that of a parent, guardian or other legally
responsible person, is advisable. Safety of
the drug or device shall have been assessed
in adult populations prior to use in
children.

7.PMA endorses the general prin-
ciple that, in the case of the mentally
infirm, consent should be sought from
both an understanding subject and from
a parent or guardian, or in their absence,
another legally responsible person.

8. Pharmaceutical manufacturers
sponsoring investigations in prisons must
take all reasonable care to assure that the
facilities and personnel used in the con-
duct of the investigations are suitable for
the protection of participants, and for the
avoidance of coercion, with a respect for
basic humanitarian principles.

9. Sponsors intending to conduct non-
therapeutic clinical trials through the
participation of employee volunteers
should expand the membership and scope
of its existing Medical Research Commit-
tee, or establish such an internal Medical
Research Committee, with responsibility
to approve the consent forms of all
volunteers, designs, protocols and the
scope of the trial: The Committee should
also bear responsibility to ensure full
compliance with all procedures intended
to protect employee volunteers’ rights.

10. Where the sponsor obtains medi-
cal information or data on individuals, it
shall be accorded the same confidential

status as provided in codes of ethics gov-
erning health care professionals.

11. PMA and its member firms accept
responsibility to aid and encourage ap-
propriate follow-up of human subjects
who have received investigational prod-
ucts that cause latent toxicity in animals
or, during their use in clinical investiga-
tion, are found to cause unexpected and
serious adverse effects.

12. PMA supports the exploration
and development by its member compa-
nies of more systematic surveillance pro-
cedures for newly marketed products.

13. When a pharmaceutical manu-
facturer concludes, on the basis of early
clinical trials of a basic new agent, that a
new drug application is likely to be sub-
mitted, a proposed development plan
accompanied by a summary of existing
data, would be submitted to the FDA.
Following a review of this submission,
the FDA, and its Advisory Committee
where appropriate, would meet with the
sponsor to discuss the development plan.
No formal FDA approval should be re-
quired at this stage. Rather, the emphasis
should be on identification of potential
problems and questions for the sponsor's
further study and resolution as the pro-
gram develops. ;

The PMA believes that health profes-
sionals as well as the public at large
should be made aware of these 13 points
in its Policy on Clinical Research. For
these recommendations envisage con-
structive, cooperative action by industry,
research institutions, the health profes-
sions and government to encourage crea-
tive and workable responses to issues
involved in the clinical investigation of
new products.

TP.M-A| Pharmaceutical Manufacturers

ee aS Association

LHR 1155 Fifteenth Street, N.W.
Washington, D.C. 20005

ANNUAL REPORT
OF THE
MARYLAND BOARD OF PHARMACY

In compliance with the provisions as set forth in Section 258 of
Article 43 of the Annotated Code of Maryland, this report is
submitted to the Honorable Marvin Mandel, Governor of Mary-
land, and to the Maryland Pharmaceutical Association. This is
the seventy-fourth report to the Governor of the State and the
sixty-fourth to the Association. The report covers the activities
of the Maryland Board of Pharmacy for the fiscal year ending
June 30, 1976. This report is also being submitted to the Secre-
tary of Health and Mental Hygiene, the McKeldin Library of the
University of Maryland, the Enoch Pratt Free Library, the De-
partment of Legislative Reference, the Hall of Records and the
State Library.

Personnel

During the year the Board held eighteen meetings, three of
which were held at the Allied Health Professions Building of the
University of Maryland, for the purpose of conducting examina-
tions for registration of pharmacists.

At the meeting of the Board on July 9, 1975 the Board reor-
ganized and elected Mr. Morris Yaffe President and Mr. C. H.
Tregoe Secretary-Treasurer. Mr. Donald H. Noren, Director of
the Environmental Health Administration, felt there could bea
conflict with the Chief of the Division of Drug Control also
being the Secretary-Treasurer of the Maryland Board of Phar-
macy, and that Mr. Tregoe should phase out of his activities as
Secretary-Treasurer of the Board within the year.

At the meeting of the Board on March 24, 1976, Mr. Robert E.
Snyder was elected Temporary Secretary-Treasurer.

Examinations

The Board conducted two examinations for registration of
pharmacists during the fiscal year. The first was held at the
School of Pharmacy of the University of Maryland on November
5,6, and 7, 1975. There were eighteen applicants who took the
full examination. Two applicants failed. There was one applicant
who took only the theoretical portion of the examination.

On June 16, 17, and 18, 1976 the Board of Pharmacy conducted
another Board Examination at the Allied Health Professions
Building at 22 South Greene Street. There were one hundred
and one applicants who took the entire examination. Twenty-
five applicants took the theoretical portion of the examination
since they did not have the required experience to take the full
Board. Two applicants took only the practical portion of the
examination. One applicant took only the practical portion be-

22

cause she did not have the required experience for reciprocity
and the other applicant took the practical portion because he
had taken only the theoretical portion in November of 1975.
There were a total of one hundred and twenty-eight applicants
taking the examination during June.

The Standard Examination of the National Association of
Boards of Pharmacy was given (as prepared by the Educational
Testing Service of Princeton, New Jersey) which consisted of the
following subjects:

Practice of Pharmacy
Pharmacology

Math

Chemistry

Pharmacy

The Jurisprudence examination which was compiled by a
member of the Board was given as part of the practical portion
of the examination. The results of the examination are not as yet
available.

The following table shows the number of pharmacists who
were registered by examination during the past ten years.

Year Number of Pharmacists
1966-1967 58
1967-1968 41
1968-1969 60
1969-1970 93
1970-1971 112
1971-1972 133
1972-1973 96
1973-1974 111
1974-1975 le?
1975-1976

As in the past, many pharmacists applied for reciprocal regis-
tration in Maryland for various reasons. In all cases an applicant
for reciprocal registration must appear for a personal interview.
the entire Board must act on whether or not to grant registration
to such applicants, who must sign agreements to comply with
Maryland’s laws pertaining to drugs and pharmacy.

The following table shows those granted registration by re:
ciprocity thus far during the 1976 Fiscal Year.

THE MARYLAND PHARMACIS.

Name

MD IAP CD ices ou ooo siale ves
fmmiart M. Becker ...............0..0-
Re OC AN Gace naa kv dn Line OY
Meat tae) TRU Soret nyc «ee ky oe

mearinan M: Gitomer.........2...053-
Judith DOL VEST Meher e ss ocien a aso xs
BETES ANIKOW fare sae fs bese d en sae
Mary Ann Oksza-Chocinowski
frederick L. Munford................
(Clark I, TRO R TPO 9 8 A pie ae ea ee
ne Sei ey LS rer ear
MME SLIOMISKY 6 acc esa. ne sees es
MMM ION cree chest k caus iss:
Berean. Kopelman .5<-2.¢ss45-..-
RRR CU UW oe ce picieice es bane < s « s
BHCKDeEPOIO Jia iii la ib ee es
Mark E. BOC See era estes chee colle ses
Maint (oe GIOWACKI she 20s o cials a aie ds
MMTLEeLLCLet Ser kirs oes Piso oes
mealiace Kleinman .....<:.......2.00:

Wilhelm-Hermann Reibert

Benjamin Hodes ....................
Mtuerne L..del Padre .2....00.005...
Godfrey St LATENT aks eee ee erie
Meteor NgallsS eee es os
Jaspal SmBKOCK Nate merrier tenis ae ne
MEER EVV ONC sr. ad Cole ea fs cae

BREA eM alla coon a5 <3 a ere os pie eee
Bee CNSCUM rete oth oid ols Quotes aoe «he
MisMe RUDENSTEIN... .s. 005-50. ecees
BEMIS EI Seats ts ace ss see oe lae's
EMME PE ECKL EV a oe faye chron tated ware e os
PEST Ge GU) Ag Sg
meeatlina V. McMahon...2............
MUEATIUA BIN OWie. oi cin os vn Sewn nies bs
IESE. SNORING. hve ces whee us a8
Mean M AS aVet sie in « oecas.s shoes
MMM ECTSOSFAUSG EE es tal SA 5. oie, ca 5
EEA SC TU ira wth eek osrs a5 ew
Kenneth C. Davis ...............00:-
RECUR ISCI ete ate ois Sale nae Niece
GEM aT (ci fa EWR a ne ee eres
mene ©. Nowosiwsky ..........-.+-:

JULY, 1976
|

Registered By Reciprocity

Ste RI 8223
BAe SPDs ani 8224
eee ee 8225
ary PERE eae 8226
ie bine hate bias 8228
Raat shire <9 See 8230
ee SOR Fe 8231
Chale sian ssa BOs 8233
reed Bey esa Me 8234
bag Sei ser os tude. 2. «, wtla 0s 8124
eee eRe emis 8236
Peepers shearer Etat 8237
SRR tre! aio sti. 6 8238
aibhera 8 taste ts 8239
See Oe toe 8240
Riso crave chain cttes 8241
Re ae me etl ors 8242
EGR ates a 8243
Dean wee oe 8244
See UP Moe 8245
ee Ses rie ERS ed as 8246
OO ES 8247
pierre shale Voor 8248
epogees osu aie oae%e 8249
EN eee a 8251
weer We Gal arses 8252
Sean ean es 8253
See saver epnietes 8254
Reyes eens aus 8255
Se uig aeeatasie § © 8256
Se sare ee ass 8257
Bens Fest, ss 8258
Phe ene on 8259
oreyaiate W onsna iets 8260
fasts is sie ea 8261
ap ear ee 8262
Sapiens wicetays 8263
Se tie tod mene 8264
ety ke 8265
Ato da DAE te tla srs 8266
Eee isha s sales 8267
Pome waters 8268
Fe een EE 8269
acces ones 8270
So oe eae 8271
Sate WRG lnea: 8300
Wee rn 8301
A eerie: iit 8302
Ore re Cate 8303

Certificate

Number Dated
July 16, 1975
July 17, 1975
July 17, 1975
July 17, 1975
August 1, 1975
August 1, 1975
July 28, 1975
July 23, 1975
July 30, 1975
August 1, 1975
August 1, 1975
August 1, 1975
August 5, 1975
August 13, 1975
August 13, 1975
August 29, 1975
September 22, 1975
September 22, 1975
September 22, 1975
September 22, 1975
September 22, 1975
September 22, 1975
September 22, 1975
September 22, 1975
October 6, 1975
October 6, 1975
October 14, 1975
October 15, 1975
October 15, 1975
October 15, 1975
October 15, 1975
October 16, 1975
October 20, 1975
October 31, 1975
October 31, 1975
October 31, 1975
October 31, 1975
November 13, 1975
November 20, 1975
November 20, 1975
November 20, 1975
November 20, 1975
November 20, 1975
November 20, 1975
November 20, 1975
December 19, 1975
December 19, 1975
December 19, 1975
December 19, 1975
January 5, 1976

hah nis Si 8306

State

South Carolina
New York

Nevada

Tennessee

Idaho

New Jersey

District of Columbia
lowa

New York

West Virginia
District of Columbia
New York

New York
Pennsylvania

New Mexico

Ohio

Pennsylvania

West Virginia

New York

lowa

Kentucky

New Jersey
Pennsylvania
Pennsylvania
District of Columbia
District of Columbia
New York

Rhode Island
District of Columbia
Rhode Island
District of Columbia
North Dakota

Ohio

Ohio

West Virginia
Virginia

New York
Pennsylvania
District of Columbia
Pennsylvania
District of Columbia
Tennessee

Virginia
Massachusetts

New York

Nevada

Louisiana

Utah

Utah

Pennsylvania

23

The following table shows the number of pharmacists granted Allegany wares: eawers 3 Fredernck’ 3. ese yes 1 |

registration by reciprocity and the number who were certified Anne Arundel........ 3 Gatrettiz.. ..4 1 |
to register by reciprocity in other states during the past ten Balti noresecen ts scene 10 Harford: cosa eon 2
years. Calveriowns seach entaars 1 Howard. sovcee eee 2 |
(Carte liane era a actars 3 Kent) c2< decane 1
ro Certified for Ceci taper ee. gee 1 Montgomery......... 6
Heke ots Sorahne Seen aa GharleSmnnc.m a. een 1 Prince Georges ...... 3
DoOrchestereriaas een. « 1 St. Mary's (22. eceeee 1]
1966-1 96 /eaneen ccs «ote 61 27, SOMEeErsSeti eee 1 |
1967-1968 5 igs areca ee oe 64 20 Washington vee 1 |
9968-1969 5. sate Stes poker 84 27 BaltimorerCity neces: 26 WICOMmICO @ 02 eeee 2
1909-1970 1 s dewaasieen sa i mal Total Hospital Pharmacies ........... 2 some 70
19Z0=19 7 Meera cee rere. 92 26
Fc = enna a = The following table shows the number of pharmacies
1973-1974.............. 88 63 opened, changes in ownership and closed during the year:
1974-1975 ies eels eee 76 45 Changes in
1975-19760. 23 en ee 0m 49 Cancenin
Tofalascaeees 751 389 OD AES
Opened and/or Closed
This table shows that Maryland gained 362 pharmacists by Address
reciprocity during the past ten years.
GOUNTICS Hanan AZ, 9 5
Baltimore City ...... 8 8 8
Hivos) (alts Tiel cs etee 25 4
Location 1974-75 1975-76
The following table shows the number of pharmacies
Counties: opened, changes in ownership, etc. and closed in the past ten
Allegany ac ceca es 26 24 years.
Anne Arundel ........ 54 58
Halinicrc ee 152 157 Fiscal Year Opened Changes Closed
Calvert, t4%-acenee: 3 3
CArcline em eee 3 3 966-19 Geer 41 Day. 25
1967519605 Sees 24 Sy, oS
Carrollieeeec. were 15 7 1968-19601 ee 34 19 51
Ce eee ee ee eres : i 196931970 ee 20 21 19
Charles ee f L 1970-197] a ee 24 28 40
Dorchester...-....... S t 1971-1972 27 a 21
Frederick 2.0... re 16 17 1972-1973 .......... 25 41 29
Garrett .............. 5 5 197321974 eee 34 30 21
HartOrdh nts eee tae 26 26 197421075 44 18 25
FIGWald cae ees 15 ee 19075-1976 a als 47 13
KENntiie.ce cn aaa 4 4
Montgomery s2a-- o2-. 100 103
Prince George’s ...... 105 106 Certificate Of Registration Renewals
QOueensAnne States 4 4 ; :
Saline Maree eee 6 6 The following table shows the renewal periods and the total
SOMEISCL C405 ues 4 > AUT EVE SOLES
Talbot ............... 2 G Renewal Period Total Renewals
Washington .......... 19 a1
WICOMICO =~ cae 13 13 1961-1962 2,368
Worcester: =. con eeee SEI 11 1963-1964 2,425
County Totals.e ee 607 626 1965-1966 2,663
Baltimore City........ 189 191 1967-1968 2,762
anion iain 1969-1970 2,900
State-wide Totals ......... 796 817 1971-1972 3,084
1973-1974 3,342
The above figures include permits issued to hospitals in the 1975-1976 3,480

counties as follows in the next column.

24 THE MARYLAND PHARMACIST

Manufacturers’ Permits

Permits to manufacture drugs, medicines, toilet articles, den-

_tifrices or cosmetics during 1976 were issued to 31 firms. An

applicant applying for a permit for anewly established company
is required to appear before the Board and to furnish all infor-
mation the Board considers pertinent to the conducting of such
operation.

Dangerous Drug Distributors’ Permits

The Board issued 105 permits to sell, distribute, give or in any
way dispose of dangerous drugs during 1976. It is not necessary
for a subsidiary or subsidiaries of acompany to have a separate
permit, as they are covered under the permit held by the parent
company.

Legislation

The following legislation which affects the profession of
Pharmacy either directly or indirectly was enacted by the 1976
Maryland General Assembly and signed into law by Governor
Marvin Mandel.

House Bill 596

SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF
MARYLAND. That Sections 257 and 258 of Article 43 Health, of
the Annotated Code of Maryland (1971 Replacement Volume
and 1975 Supplement) be and they are hereby repealed and
reenacted, with amendments to read as follows:

Article 43 — Health

(A) THEREISA Maryland Board of Pharmacy, which IS part of
the Department of Health and Mental Hygiene.

(B) (1) THE BOARD CONSISTS OF SEVEN MEMBERS
KNOWN AS COMMISSIONERS OF PHARMACY.

(2) OF THE SEVEN Commissioners SIX shall be skilled and
competent pharmacists, who have had at least five years’ active
pharmaceutical experience in compounding and dispensing
physicians’ prescriptions, and of whom at least FIVE are actively
engaged in the practice of pharmacy; AND ONE SHALL BE A
CONSUMER.

(3) None of THE Commissioners shall be connected with
any school of pharmacy either as teacher, instructor, or
member of the board of trustees.

(4) Two Commissioners shall be residents of the City of
Baltimore, two SHALL BE residents of the counties of the State,
and THREE MAY BE RESIDENTS of either the City of Baltimore or
the counties of the State.

(C) The Commissioners shall serve ON THE Board for A term
of five years.

(D) (1) EACH PROFESSIONAL MEMBER OF THE BOARD
SHALL BE APPOINTED BY the Governor, ON recommendation
of the Secretary of Health and Mental Hygiene, from a list of
pharmacists of three times the number of vacancies to be filled,
submitted by the Maryland Pharmaceutical Association.

(2) EACH CONSUMER MEMBER OF THE BOARD SHALL
BE APPOINTED BY THE GOVERNOR, ON RECOMMENDATION
OF THE SECRETARY OF HEALTH AND MENTAL HYGIENE.

JULY, 1976

(E) AFTER notification of HIS appointment each COMMIS-
SIONER SHALL subscribe to the oath prescribed by the Con-
stitution of the State of Maryland.

258.

(A) THE Board shall ELECT FROM AMONG THE SIX PROFES-
SIONAL MEMBERS a president, secretary and treasurer, who
shall serve for the term of one year and who shall perform the
duties prescribed by the Board.

(B) Meetings for the examinations of applicants for registra-
tion shall be held on the first Thursday in April and October in
each year, in the City of Baltimore, or at THE times and places
fixed by the Board. HOWEVER, ten days’ public notice of the
hour and place of each meeting at which there is an examination
of candidates for registration shall be given.

(C) It shall be the duty of the Board to:

(1) RECEIVE all APPLICATIONS for examination and regis-
tration submitted in proper form AND grant certificates to per-
sons entitled to LICENSURE UNDER THIS SUBTITLE:

(2) REPORT annually to the Governor, the Secretary of
Health and Mental Hygiene, and the Maryland Pharmaceutical
Association upon the condition of pharmacy in the State, which
report shall also furnish a record of the proceedings of the
Board, as well as the names of all persons registered under
these provisions; AND

(3) KEEP abook in which shall be registered the names and
places of business of all persons UNDER THIS SUBTITLE and all
facts pertaining to the granting of certificates.

(D) The Board shall have the power to:

(1) ADOPT any rules and bylaws necessary to the transac-
tion of the business of the Board; AND

(2) DEMAND and receive from applicants the fees pro-
vided FOR IN THIS SUBTITLE which the treasurer of the Board
SHALL PAY OVER to the Treasurer of the State.

(E) The Board may promulgate rules and regulations, in ac-
cordance with the Administrative Procedure Act, governing the
standards of practice of pharmacy and operation of pharmacies
including, rules and regulations governing the method of ad-
vertising, promotion and standards for filling and FOR refilling
prescriptions, necessary to protect public health, safety, and
welfare.

SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall
take effect July 1, 1976.

Cooperative Activities

The Board maintained membership in the National Associa-
tion of Boards of Pharmacy. The annual meeting of the Associa-
tion was held in Lake Buena Vista, Florida May 15-19, 1976. The
Board was represented by President Morris R. Yaffe, Commis-
sioner Ralph Quarles and Secretary Robert E. Snyder.

The Board also maintained membership in the Conference of
Boards and Colleges of Pharmacy of the National Association of
Boards of Pharmacy, District Number Two, comprising the
states of New York, New Jersey, Pennsylvania, Delaware, Mary-
land, the District of Columbia, Virginia and West Virginia. The

Fhe)

annual meeting was held in Annapolis, Maryland on October 30
— November 1, 1975. The Board was represented by President
Morris R. Yaffe, Mr. Charles H. Tregoe.

The Board maintained cooperative activities with the State
Department of Health and Mental Hygiene, the School of Phar-
macy — University of Maryland, the Maryland Pharmaceutical
Association, the Baltimore Metropolitan Pharmaceutical Asso-
ciation, the Food and Drug Administration, City, County and
State Police.

Finances
All funds of the Board of Pharmacy are deposited to the credit
of the Treasurer of the State of Maryland and disbursements
covering the expenses of the Board are paid by voucher by the
State Comptroller.

Pay
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26

DONT THINK OF IT AS CHARITY.

Report of the
Maryland Board of Pharmacy

List of Deceased Pharmacists

Morton Arbanel

Aaron Abramson

Israel Baker

Joseph Belford

George Black

Charlotte Bosch Schollech
Sister Mary Carmel Clarke
Benjamin Chester Cwalina
Michael Dausch

Harold T. Derry

Frank Dingus

Sidney Herbert Flom
Samuel Lewis Fox

Harry Joel Goldberg
Sylvan Goodman

Ernest Helgert

George Karman

Maxwell Alvin Krucoff
Irvin Kemick

Frank Ferdinand Levay
Norman J. Levin

Benedict Casimir Malinowski
Keith L. Morrish

Jerome Pinerman

Gifford Le Grand Potts
Dexter Reinmann
Raymond C., Robinson
Demitrious Rodriguez
Elbert William Schotta
Morris Shenker

Isidore Irvin Small (ovitz)
Jerome Snyder

Simon Solomon

Isaac Standiford

Edward Charles Vojik
Raphael Hyman Wagner
William Weltner

Respectfully submitted,

Robert E. Snyder, Secretary
Maryland Board of Pharmacy

THE MARYLAND PHARMACIST

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'ULY, 1976 27

OPEN FORUM

One of the most important aspects of the community phar-
macist’s practice is the renewal of medications. Certain classes
of medications are regulated as to the number of refills within a
given period of time. Most pharmacists agree that the 6 months
or 5 refills for abused medication has made the pharmacist-
patient relationships concerning the renewal of these medica-
tions easier to deal with. Rules or guidelines concerning renew-
ing of other classes of medications might also be helpful.

Since the physician’s writing habits directly affect the phar-
macist, we should be especially scrutinizing of those habits and
guide them to our mutual benefit. Too many physicians write
prescriptions with no indications of refills. Some physicians
write one refill and have the pharmacist call the next 5 or 10
times for further renewals.The telephone exercise is time con-
suming and in over 99% of the requests which | have surveyed
the answer was “Yes’’ — refill the medications. If the answer is
yes, why didn’t the physician say so when he wrote the original
prescription? Is ita game they play with the valuable time of the
pharmacist and patient? The folly of this situation is that most of
the refill information is conveyed by an office employee — not
the physician. One office worker told me that she could not
refill this prescription because it was not on the drug list that the
physician composed with instructions to her for refills. Pharma-
cists are spending a large part of their productive time talking to
office employees who generally can’t even spell the renewal
request. It is time for a set of refill guidelines as follows:

1. Prescriptions with the exception of Class Il medications
that do not advise the pharmacist as to whether or not refills are
indicated, would be refillable 3 times within 3 months.

2. If aprescription indicates no refills or has been refilled the
number of times indicated then the patient would be required
to establish the medical need to continue the prescribed medi-
cation. No longer would the pharmacist solicit physicians for
the renewal of medications. The pharmacist would only call the
physician after the patient has discussed his need for a renewal
and been advised to continue the medication. The pharmacist’s
duty would be to confirm and not solicit renewals. The present
method is a waste of everyone’s time and effort. Patients re-
quest pharmacists to refill prescriptions that are years old. The
pharmacist then becomes the patient’s solicitor of the physician
who in many instances has not seen the patient in two years and
refuses the refill. The physician who refuses to designate refills
on the prescription but refills the medication each time the
pharmacist calls should be required to speak to the patient
before the pharmacist could refill the prescription. The physi-
cian might then be inclined to think ahead to the patient's future
renewals since he must be contacted regularly by the patient
before the pharmacist could renew the medication.

3. Certain classes of medications such as antihistamines, de-
congestants, or combinations thereof should be refilled accord-
ing to the request of the patient and the judgment of the phar-
macist for 6 months unless specifically prohibited by the physi-
cian.

4. Prescriptions should be automatically cancelled after one
year from the date of filling and require the patient, not the
pharmacist, to solicit the physician for renewal, and the phar-

28

macist to confirm with the physician the continuation of th
medication.

M. Neal Jacobs, R.Ph.

Belair Professional Pharmacy

7414 Laurel-Bowie Road

Bowie, Maryland

|

ASCP Seminar
Features Drug/Nutrition Interface
In The Geriatric Patient

The American Society of Consultant Pharmacists is sponsor-
ing a seminar on ‘‘Nutritional Management of the Geriatric
Patient’ September 15, 1976, at the Sheraton Airport Hotel in
Philadelphia. The day-long program opens with an overview of
physiological and biological changes that occur with aging and
influence both the general nutritional balance and the drug/
nutrient synergism in medical therapy. The seminar, designed

|
.
'

|

i

i

\

|
|
:

for team participation of consultant pharmacists and dieticians, ©
will detail the drug/nutrient interface and the team approach to

nutritional management of the geriatric patient.

Subjects scheduled are: drug/nutrient interactions and their
implications for the pharmacist, the nurse, and the dietician;
special formulations and dietary modifications for the geriatric
patient and guidelines for evaluation and techniques of ad-
ministration; the team approach to nutritional management
and a series of case studies in the long-term care setting.

Following the lecture sessions, participants will break into
workshop groups to implement the team approach to nutri-
tional management using programmed cases which may be
encountered among the institutionalized elderly.

In 1900, one of every 25 persons was over 65 years of age; in

|

1970, one out of ten persons was over 65; the number of per-

sons over 75 years old has been increasing at double the rate of
the total population.

For further information write: ASCP, 2300 Ninth Street,
South, Suite 415, Arlington, Va. 22204.

Futeral Cited For Work With Youth

Nathaniel Futeral, owner of Gera Pharmacy in Baltimore, was

the recipient of the Presidents Award of the Union of Orthodox —

Jewish Congregations of America for his contributions to the
National Conference of Synagogue Youth.

Gilpin Reaches Record
Sales And Earnings

The Henry B. Gilpin Company, drug wholesalers, announced
record sales and earnings for the year 1975. Consolidated net
sales rose to $72,936,137, a 14% increase over $64,090,904 for the
previous year. After tax earnings increased from $527,584 in 1974
to $534,643 in 1975, or 85¢ per share. The Board of Directors
declared a 5% stock dividend to stockholders.

Gilpin operates six wholesale drug distribution centers, serv-
ing thirteen states in the East, South, and Midwest. The firm also

Operates drugstore franchising systems, service merchandis-
ing, and surgical supply subsidiaries.

THE MARYLAND PHARMACIST

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Prince Georges—-Montgomery County Pharmaceutical Association
Installation And Scholarship Fund Dinner Dance

im |

a

Edward S. Sandel, outgoing president, be-
came Chairman of the Executive Commit-
tee.

Richard D. Parker, Installation Officer

IULY, 1976

. Sarr 2
ii Lite 4 oo d
on imi ia

: toee = igi
= ret st tas
‘7.

ai |

Left to right: Louis N. Nobel, 4th Vice President; Leonard J.
DeMino, 1st Vice President; Henry W. Theis, Jr., President;
Robert L. Koenig, Treasurer; Paul Reznek, Secretary, and Eric
Kramer, 3rd Vice President.

Officers and executive committee of the Prince Georges—-Montgomery County
Pharmaceutical Association were installed on May 23, 1976, at the Indian Spring
Country Club in Silver Spring.

MPhA Vice President Richard D. Parker was Toastmaster and Dr. William J.
Kinnard, Jr., Dean of the University of Maryland School of Pharmacy, was installa-

tion officer.

The 1976-77 officers are: Henry W. Theis, Jr., President; Leonard J. DeMino,
1st Vice President; Morton H. Katz, 2nd Vice President; Eric Kramer, 3rd Vice
President; Louis N. Nobel, 4th Vice President; Paul Reznek, Secretary, and Robert
L. Koenig, Treasurer. Executive Committee: Edward S. Sandel, Chairman; Stanton
P. Brown, Marilyn Arkin, Deborah Arbogast, Russell A. Gobeille, Jonas Rose, Irving
1. Siegel, Edward D. Nussbaum, Gerald Y. Dechter and Melvin J. Sollod. Ex-officio:
Herman Bloom, Paul Gallagher, Gary McNamara and Ben S. Mulitz.

The Past President’s Award to Edward S. Sandel was made by Gary McNamara
of the H. B. Gilpin Company. The awards to President Theis were made by Les Lattin
of the Washington Wholesale Drug Exchange and Ben Mulitz of District Wholesale

Drug Corporation.

31

Reems oe

THE MARYLAND PHARMACIST

32

ALUMNI ASSOCIATION
UNIVERSITY OF MARYLAND SCHOOL OF PHARMACY

50th ANNUAL GRADUATION BANQUET
| Eudowood Gardens — June 2, 1976

i
Top row, left) Henry G. Seidman (left) is installed as president by Charles E. Spigelmire, installation officer. (Center) Past President
5am A. Goldstein delivers the invocation. (Right) Christopher L. Shawyer, President, Class of 1976, expressed appreciation on behalf
of the class who were guests of the Alumni Association.

(Middle row, left) Seated left to right: Henry G. Seidman, president; Dorothy Levi and William Weiner, Executive Committee;
Standing: Stephen Bierer, Executive Committee; George C. Voxakis, 2nd Vice President; Leon Weiner, Executive Committee
Chairman; Herman Bloom, Honorary President; Sanford L. Rosenbloom, Executive Committee; H. Nelson Warfield, Treasurer
Emeritus; Charles A. Sandler, Executive Committee; Ronald A. Sanford, Treasurer. (Right) Charles E. Spigelmire (left) received
Honored Alumnus Award from Nathan I. Gruz, Executive Director, MPhA and past president of the Alumni Association.

|
(Bottom row, left) Alex M. Taylor, center, Class of 1976, receives first Frank J. Slama Memorial Award for excelling in extracurricular

‘activities from Mrs. Slama and H. Nelson Warfield. (Center) George C. Voxakis delivers the benediction. (Right) Alumni Banquet
Chairman Sanford L. Rosenbloom with Mrs. Rosenbloom as they greeted arrivals.

|
;

CLASS OF 1926 AT ALUMNI BANQUET
RECEIVE 50 YEAR CERTIFICATES

1 = me

| us 2 . as

(Left to Right) Aaron Rosenstein, F. Harold Lewis, Jack Schneider, Bernard G. Shure, Joseph E. Sears, Harry E. Glennan, Morris Wolfe
and Bernard J. Diamond.

(RJULY, 1976 a3

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ANNE ARUNDEL COUNTY PHARMACEUTICAL ASSOCIATION

he following 1976 officers of the Anne Arundel County Phar-
maceutical Association were installed at a dinner dance at Em-
pire Towers, Severna Park.

Bennie G. Owens was presented the past president's plaque
by incoming president, Nathan Schwartz of Annapolis. Vincent
|. Regimenti was chairman of the installation dinner dance and
toastmaster. Nathan |. Gruz, Executive Director of the Maryland

Pharmaceutical Association installed the following officers:
President: Nathan Swartz; 1st Vice President: Vincent J. Re-
gimenti; 2nd Vice President: William H. Borcherding; Treas-
urer: Robert A. Harnish; Secretary: Roberta Van Duzer; Assis-
tant Secretary: Albert Friedman. Executive Committee in-
cludes: Howard M. Wertheim, Albert Friedman, Alder |. Simon,
Milton R. Watkowski and Bennie G. Owens.

Bennie G. Owens (left) received past president’s plaque
from incoming president Nathan Schwartz (right).

MPhA Executive Director
Nathan I. Gruz served as Instal-
lation officer.

Installation Chairman and Toastmaster was 1st
Vice President Vincent J. Regimenti.

Upper Bay Pharmaceutical Association

The Upper Bay Pharmaceutical Association announces its
schedule of remaining meetings for 1976. Executive Committee
meetings will be held on Tuesday, October 12, and Tuesday,
December 14 at 10:15 P.M. at Dell’s Pharmacy which is located at
15 W. Bel Air Ave., Aberdeen, Md. In addition, the regular
meeting will now be held monthly at Bush River Yacht Club on
the third Wednesday of each month, at 10:15 P.M.

The following members are now serving as Chairpersons of
their respective committees: David H. Ayres, Legislative; Bar-
bara C. Barron, Membership; John W. Conrad, Jr., Programs;
James L. Ter Borg, By-Laws; Joseph M. Wright, Public Relations;
Joseph S. Freeman, Nominating; and Charles V. Bernard, Ros-
ter and Phone Squad Communication.

The 1976 officers are: Jonas J. Yousem, President; John W.
Conrad, Jr., 1st Vice President; James L. Ter Borg, 2nd Vice
President; Charles V. Bernard, Secretary; Barbara C. Barron,
Treasurer. Executive Committee: Joseph S. Freeman and
Joseph M. Wright.

JULY, 1976

BVDA 50th Anniversary

The Baltimore Veteran Druggists Association will celebrate its
Fiftieth Anniversary on Friday, September 10, 1976. This historic
reunion of Associates will occur at the Victorian Room in the
Broadview Apartments on 39th Street in Baltimore at 12:30in the
afternoon. As part of the program, Dr. B. F. Allen will review the
“History of the Baltimore Veteran Druggists Association.”

Allegany—Garrett Officers

At the May 22, 1976 meeting of the Allegany—Garrett Counties
Pharmaceutical Association the following officers were elected
for one year terms to expire in May of 1977: Ernest J. Gregg, Jr.,
President; Joseph L. House, Vice-President; and Patrick E.
Trost, Secretary-Treasurer. Any correspondence to this organi-
zation should be addressed to Patrick E. Trost, 922 Dolly Ter-
race, LaVale, Maryland 21502.

35

oloiltuaries

RAPHAEL H. WAGNER

Raphael H. Wagner, 75, a founder of the Wagner & Wagner
Pharmacy on Cold Spring Lane in Baltimore, died June 6.

Mr. Wagner came to this country from his native Austria at the
age of 12 and started his education at the German-English
grammar school. He later graduated from Polytechnic Institute
and the University of Maryland School of Pharmacy in 1923.

His first pharmacy, which he operated with his brother Man-
uel, was located at Baltimore and Eutaw Streets, but after three
years he moved to the 500 block Cold Spring Lane in 1926. He
retired in 1974, turning the business, which once had encom-
passed five stores, over to his son Herbert, also a pharmacist.

Mr. Wagner was a past president of the Alumni Association of
the University of Maryland School of Pharmacy, and a member
of Amicable Lodge A.F. &. A.M., Yedz Grotto, Scottish Rite and
Shriners. He was also active in the Green Spring Synagogue
Center and the Beth Tfiloh Congregation.

He is survived by his wife of 45 years, the former Rose A.
Waller; three sons, Herbert C., Daniel E. and Dr. Arthur
Wagner; two daughters, Mrs. Zell Hurwitz and Mrs. Maurice
Feldman; and 10 grandchildren.

ALBERT FRIEDMAN

Albert Friedman, 64, for 27 years the proprietor of Onnen’s
Pharmacy at Sharp and Hamburg Streets, died June 20, 1976,
after an illness of one year. He was a member of MPhA and
BMPA.

Mr. Friedman was a graduate of City College and the Univer-
sity of Maryland School of Pharmacy in 1930. He was known to
his South Baltimore patrons as “Doc Onion.”

He was also a member of the National Association of Retail
Druggists and the Beth Jacob Brotherhood.

Survivors include his wife, the former Sara Baylin; a son,
Martin Friedman; two daughters, Mrs. Janice Dancikerand Mrs.
Marlene Friedman and two grandchildren.

EDMUND A. CORNBLATT

Edmund A. Cornblatt, 69, retired Baltimore pharmacist, died
June 30. He had been a member of the MPhA and BMPA.

Born in Baltimore, Mr. Cornblatt graduated from City College
in 1926 and the University of Maryland School of Pharmacy in
1929:

Throughout the 1930’s and during the early 1940’s, Mr.
Cornblatt operated the Oliver Pharmacy, located at Bond and
Oliver Streets. From 1945 until going into semi-retirement in
1967, he was a partner in the Superior Drug Company, at Wash-
ington Boulevard and DeSoto Road. During his retirement, he
worked as a part-time pharmacist at the Mount Wilson State
Hospital and the Crestlyn Pharmacy.

36

Mr. Cornblatt was a member of the Box 414 Association, the
Amicable Masonic Lodge No. 25 and the Chizuk Amuno Con-
gregation.

He is survived by his wife, the former Sarah Paul; a son,
Theodore B. Cornblatt of Randallstown; one daughter, Mrs.
Dorothy Ginsberg of Randallstown; two brothers, two sisters
and five grandchildren.

Care Drug Centers of
Washington Metro Area Launched

Nineteen independent drug stores in the metropolitan
Washington-Maryland-Virginia area joined with other inde-
pendents in ten states as ‘Care Drug Centers” under the “Care
Drug Center’ emblem. Capitalizing on this enhanced leverage
and economy of scale, they believe they can more effectively
compete for price image while maintaining the high level of
personal service and lower overhead enabled by ownership/
management. The group selected the Care Drug Center Ser-
vices Division and Wholesale Drug Division of The Henry B.
Gilpin Company in Washington.

The promotions and advertisements of the “voluntary chain”
are prepared, merchandised and supplied promotional goods
by the Care Drug Center Services headquarters team, led by
Harrison L. Leach (Gilpin’s Vice President for Retailer Services)
and includes Robert Schoellhorn.

The Care Drug Center headquarters provides similar service
to groups in other areas which have a combined total of approx-
imately 150 stores.

Officers of the Care Drug Centers of Washington group are:
Ivan Roop, President (Springfield Pharmacy, Virginia); Richard
D. Parker, Vice President (Kensington Pharmacy, Maryland);
Luke Stephens, Secretary (Dumfries Pharmacy, Virginia); Mel-
vin Chaiet, Treasurer (Hollywood Drug, Maryland).

$$. rae
Early Pharmacy Continued from page 19

16. Ibid.

17. Ibid.

18. Reference 14.

19. Reference 9, p. 1215

20. A. R. L. Dohme, ‘Address at the Banquet of Alumni Association of
the School of Pharmacy of the University of Maryland’, Maryland
Pharmacist, 5 (1920-30) 500.

21. David M. R. Culbreth, “Reminiscences of Early Pharmacy in Balti-
more”, Journal of American Pharmaceutical Association, 19 (1930)
285.

22. Reference 13, p. 307.
23. Reference 9, p. 1215.
24. Reference 20, p. 501.

25. Andrew G. DuMez, “Address at the Banquet of Alumni Association
of the School of Pharmacy of the University of Maryland’, Maryland
Pharmacist, 5 (1929-30) 490.

THE MARYLAND PHARMACIST

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pharmacists ?

We do. Why? Because 362
ofus at The Upjohn Company
are pharmacists. Including
the executives in this picture.

We understand the vital re-

lationship of pharmacist and
physician in the battle against
disease.

It's why we do all we can to
encourage professional de-

velopment...and to recognize
accomplishment in the field.

Care about pharmacists?
At Upjohn, we do.

©1975, The Upjohn Company, Kalamazoo, Michigan

Left to right: Reed B. Peterson, R.Ph..,
Vice President for Domestic Pharma-
ceutical Marketing; Louis C. Schroeter,
Ph.D., R.Ph., Vice President for Phar-
maceutical Manufacturing; and Anthony
J. Taraszka, Ph.D., R.Ph., Vice President
for Pharmaceutical Control.

THIRD PARTY PROGRAMS —

PRIORITIES AND STRATEGIES
An Editorial

PROCEEDINGS OF THE MPhA
94th ANNUAL CONVENTION

EPIDEMIOLOGICAL IMPLICATIONS
OF PHARMACY PRACTICE

Arlene Fonaroff

PRESCRIPTION
FOR PEACE OF MIND:

You want the peace of mind that comes from
the protection of American Druggists’
Insurance. It assures you of prompt, 100%
claims settlement for fire,
theft, liability, malpractice. We know the
pharmacists’ problems best, because
A.D.|. was founded by pharmacists, in 1906,
for pharmacists. Let Mayer and
Steinberg give you a free evaluation of your
insurance needs.

Your American Druggists’ Insurance Co. Representative —

MAYER STEINBERG":

General Insurance Agents and Brokers —

NEW ADDRESS
600 REISTERSTOWN RD. BALTO.. MD.

(301) 484-7000

The one the patient takes
is never tested.

Surprising, perhaps, butit makes sense
when you think about it.

Obviously, the actual dose of any pre-
scription drug the patient takes cannot be
tested because it would have to be broken
down for analysis—after which it could
never be used by a patient.

This means that you depend on the
manufacturer for assurance that the dose
the patient takes is identical to the ones
which have been tested.

At each step in the manufacture of a
Lilly drug, test after test confirms the in-
gredients, formulation, purity, and
accuracy —all the critical factors that as-
sure that every Lilly medicine is just what
the doctor ordered.

That’ particularly important, as you
know. The same drug made by different
companies can be chemically identical
yet may act differently in the human body
because of the many variables in the way
the drugs are manufactured.

And, ofcourse, government standards
alone do not assure the efficacy and con-
sistency—the quality of each drug you
dispense.

As we at Eli Lilly and Company see it,
the ultimate responsibility for quality is
outs.

For four generations weve been mak-
ing medicines as if people’ lives depended
on them.

600090

Lilly

ELI LILLY AND COMPANY, INDIANAPOLIS, INDIANA 46206

THE MARYLAND PHARMACIST

650 WEST LOMBARD STREET
BALTIMORE MARYLAND 21201
TELEPHONE 301/727-0746

AUGUST 1976 VOL. 52 NO. 8

Va

CONTENTS

7 Editorial — Third Party Programs — Priorities and Strategies
7 Calendar
8 Maryland Board of Pharmacy — New Appointments

11. Charles E. Spigelmire, A Pharmacist of Distinction

12 Proceedings of the MPhA 94th Annual Convention

20 Committee Reports

22 Pictorial View of the Convention

23 Tripartite Committee

24 Drug Evaluation — Ibuprofen — Further Evaluation — Thomas
Wiser

25 Epidemiological Implications of Pharmacy Practice — Arlene
Fonaroff, Ph.D.

32 MPhA News

32 LAMPA
ADVERTISERS
26-27 Burroughs Wellcome 16 Loewy Drug Company
14 Calvert Drug Company 33 Maryland News
18 District Photo Distributing Company
5-6 Geigy Pharmaceuticals 2 Mayer & Steinberg, Inc.
34 The Henry B. Gilpin Company 31 Paramount Photo Service
9-10 Lederle Pharmaceuticals 29 A. H. Robins
3 Eli Lilly & Company, Inc. 15 The Upjohn Company

SSS
eee

sore of address may be made by sending old address (as it appears on your journal) and new address
with zip code number. Allow four weeks for changeover. APhA members — please include APhA number.

The Maryland Pharmacist is published monthly, except for January, February, and March, 1976, combined,
by the Maryland Pharmaceutical Association, 650 West Lombard Street, Baltimore, Maryland 21201. Annual
Subscription — United States and foreign, $15 a year; single copies, $1.50. Members of the Maryland
Pharmaceutical Association receive The Maryland Pharmacist each month as part of their annual member-
ship dues. Entered as second class matter December 10, 1925, at the Post Office at Baltimore, Maryland,
under the Act of March 8, 1879.

NATHAN I. GRUZ, Editor

RICHARD M. SCHULZ, Assistant Editor
Ross P. Campsett, News Correspondent
HERMAN BLOOM, Photographer

OFFICERS & BOARD OF TRUSTEES

1976-77

Honorary President

MORRIS LINDENBAUM

President

MELVIN N. RUBIN—Baltimore

Vice President

STANLEY J. YAFFE—Odenton
(replacing James W. Truitt, Jr.
who resigned)

Treasurer

ANTHONY G. PADUSSIS—Timonium

Executive Director

NATHAN I. GRUZ—Baltimore

TRUSTEES

HENRY G. SEIDMAN, Chairman
Baltimore
LEONARD J. DeMINO (1978)

Wheaton

S. BEN FRIEDMAN (1979)
Potomac

RONALD A. LUBMAN (1979)
Baltimore

ROBERT J. MARTIN (1977)
LaVale

ROBERT E. SNYDER (1978)
Baltimore

JERRY OVERBECK (1977)
Salisbury

(appointed to vacated position
of Stanley J. Yaffe)

EX-OFFICIO MEMBER
WILLIAM J. KINNARD, JR.—Baltimore

HOUSE OF DELEGATES
Speaker

VICTOR H. MORGENROTH, JR.—Ellicott

City

Vice Speaker

SAMUEL LICHTER—Randallstown
Secretary

NATHAN |. GRUZ—Baltimore

MARYLAND BOARD OF PHARMACY
Honorary President

FRANK BLOCK—Baltimore

President

1. EARL KERPELMAN—Salisbury

BERNARD B. LACHMAN—Pikesville
RALPH T. QUARLES, SR.—Baltimore
CHARLES H. TREGOE—Parkton
Secretary

ROBERT E. SNYDER—Baltimore

THE MARYLAND PHARMACIS1

Tofranil- @ Geigy
imipramine

In depression

Daily Dosage Chart

Tofranil-PM®

imipramine pamoate

Initial Dose

Usual Optimum
Response Dose

Starting
Dose

J

Tas, 150
mg. mg.

One capsule
lasts from bedtime
to bedtime.

For Maintenance Therapy

A Full Range to Choose From*

dd 8 E

150 125 100 Ve

mg. mg. mg. mg.

*Each capsule contains imipramine pamoate
equivalent to 150, 125, 100 or 75 mg. imipramine
hydrochloride.

Tofranil-PM®
brand of imipramine pamoate

Indications: For the relief of symptoms of depression.
Endogenous depression is more likely to be alleviated
than other depressive states.

Contraindications: The concomitant use of monoamine

oxidase inhibiting compounds is contraindicated. Hyper-

pyretic crises or severe convulsive seizures may occur in
patients receiving such combinations. The potentiation of
adverse effects can be serious, or even fatal. When it is
desired to substitute Tofranil-PM, brand of imipramine
pamoate, in patients receiving a monoamine oxidase in-
hibitor, as long an interval should elapse as the clinical
situation will allow, with a minimum of 14 days. Initial
dosage should be low and increases should be gradual
and cautiously prescribed. The drug is contraindicated
during the acute recovery period after a myocardial infarc-
tion. Patients with a known hypersensitivity to this com-
pound should not be given the drug. The possibility of
cross-sensitivity to other dibenzazepine compounds
should be kept in mind.

Warnings: Usage in Pregnancy: Safe use of imipramine

during pregnancy and lactation has not been established:

therefore, in administering the drug to pregnant patients,
nursing mothers, or women of childbearing potential, the
potential benefits must be weighed against the possible
hazards. Animal reproduction studies have yielded incon-
clusive results. There have been clinical reports of con-
genital malformation associated with the use of this drug,
but a causal relationship has not been confirmed.

Extreme caution should be used when this drug is given

to:

—Patients with cardiovascular disease because of the
possibility of conduction defects, arrhythmias, myocar-
dial infarction, strokes and tachycardia;

—Patients with increased intraocular pressure, history of
urinary retention, or history of narrow-angle glaucoma
because of the drug's anticholinergic properties;

—hyperthyroid patients or those on thyroid medication
because of the possibility of cardiovascular toxicity;

—patients with a history of seizure disorder because this
drug has been shown to lower the seizure threshold;

—Ppatients receiving guanethidine or similar agents since
Imipramine may block the pharmacologic effects of
these drugs.

Since imipramine may impair the mental and/or physical

abilities required for the performance of potentially

hazardous tasks such as Operating an automobile or
machinery, the patient should be cautioned accordingly.

Usage in Children: Tofranil-PM, brand of imipramine

pamoate, should not be used in children of any age be-

cause of the increased potential for acute overdosage
due to the high unit potency (75 mg., 100 mg., 125 mg.
and 150 mg.). Each capsule contains imipramine

pamoate equivalent to 75 mg., 100 mg., 125 mg. or 150

mg. imipramine hydrochloride.

Precautions: |t should be kept in mind that the possibility

of suicide in seriously depressed patients is inherent in
the illness and may persist until significant remission oc-
curs. Such patients should be carefully supervised during
the early phase of treatment with Tofranil-PM, brand of
imipramine pamoate, and may require hospitalization.
Prescriptions should be written for the smallest amount
feasible.

Hypomanic or manic episodes may occur, particularly in
patients with cyclic disorders. Such reactions may neces-
sitate discontinuation of the drug. If needed, Tofranil-PM,
brand of imipramine pamoate, may be resumed in lower
dosage when these episodes are relieved. Administration
of a tranquilizer may be useful in controlling such
episodes.

Prior to elective surgery, imipramine should be discon-
tinued for as long as the clinical situation will allow.

An activation of the psychosis may occasionally be ob-
served in schizophrenic patients and may require reduc-
tion of dosage and the addition of a phenothiazine.

In occasional susceptible patients or in those receiving
anticholinergic drugs (including antiparkinsonism agents)
in addition, the atropine-like effects may become more
pronounced (e.g., paralytic ileus). Close supervision and
careful adjustment of dosage is required when this drug is
administered concomitantly with anticholinergic or sym-
pathomimetic drugs.

Avoid the use of preparations, such as decongestants
and local anesthetics, which contain any sympathomime-
tic amine (e.g., adrenalin, noradrenalin), since it has been
reported that tricyclic antidepressants can potentiate the
effects of catecholamines.

Patients should be warned that the concomitant use of
alcoholic beverages may be associated with exaggerated
effects.

Both elevation and lowering of blood sugar levels have
been reported.

Concurrent administration of imipramine with electroshock
therapy may increase the hazards; such treatment should
be limited to those patients for whom it is essential, since
there is limited clinical experience.

Adverse Reactions: Note: Although the listing which fol-
lows includes a few adverse reactions which have not
been reported with this specific drug, the pharmacological
similarities among the tricyclic antidepressant drugs re-
quire that each of the reactions be considered when imip-
ramine is administered.

Cardiovascular: Hypotension, hypertension, tachycardia,

palpitation, myocardial infarction, arrhythmias, heart block,

stroke, falls.

Psychiatric: Confusional states (especially in the elderly)
with hallucinations, disorientation, delusions: anxiety,
restlessness, agitation; insomnia and nightmares;
hypomania; exacerbation of psychosis.

Neurological: Numbness, tingling, paresthesias of ex-
tremities; incoordination, ataxia, tremors; peripheral
neuropathy; extrapyramidal symptoms; seizures, altera-
tions in EEG patterns; tinnitus.

Anticholinergic: Dry mouth, and, rarely, associated sub-
lingual adenitis; blurred vision, disturbances of accommo-
dation, mydriasis; constipation, paralytic ileus; urinary re-
tention, delayed micturition, dilation of the urinary tract.
Allergic: Skin rash, petechiae, urticaria, itching, photosen-

sitization (avoid excessive exposure to sunlight); edema
(general or of face and tongue); drug fever; cross-
sensitivity with desipramine.

Hematologic: Bone marrow depression including agran-
ulocytosis; eosinophilia; purpura; thrombocytopenia.
Leukocyte and differential counts should be performed in
any patient who develops fever and sore throat during
therapy; the drug should be discontinued if there is evi-
dence of pathological neutrophil depression.
Gastrointestinal: Nausea and vomiting, anorexia, epigas-
tric distress, diarrhea; peculiar taste, stomatitis, abdomine
cramps, black tongue.

Endocrine: Gynecomastia in the male; breast enlarge-
ment and galactorrhea in the female; increased or de-
creased libido, impotence; testicular swelling; elevation o1
depression of blood sugar levels.

Other: Jaundice (simulating obstructive); altered liver
function; weight gain or loss; perspiration; flushing; uri-
nary frequency; drowsiness, dizziness, weakness and
fatigue; headache; parotid swelling; alopecia.

Withdrawal Symptoms: Though not indicative of addiction
abrupt cessation of treatment after prolonged therapy
may produce nausea, headache and malaise.

Dosage and Administration: In adult outpatients,
therapy should be initiated on a once-a-day basis with 75
mg./day. This may be increased to 150 mg./day which is
the dose level which usually obtains optimum response. If
necessary, dosage may be increased to 200 mg./day.
Dosage should be modified as necessary by clinical re-
sponse and any evidence of intolerance. Daily dosage
may be given at bedtime, or in some patients in divided
daily doses.

Hospitalized patients should be started on a once-a-day
basis with 100-150 mg./day and may be increased to 200
mg./day. Dosage should be increased to 250-300 mg./day
if there is no response after two weeks.

Following remission, maintenance medication may be re-
quired for a longer period of time at the lowest dose that
will maintain remission. The usual adult maintenance
dosage is 75-150 mg./day on a once-a-day basis, prefer-
ably at bedtime.

In adolescent and geriatric patients, capsules of Tofranil-
PM, brand of imipramine pamoate, may be used when
total daily dosage is established at 75 mg. or higher. It is
generally unnecessary to exceed 100 mg./day in these
patients. This dosage may be given once a day at bed-
time or, if needed, in divided daily doses.

How Supplied: Tofranil-PM, brand of imipramine
pamoate: Capsules of 75, 100, 125 and 150 mg. (Each
capsule contains imipramine pamoate equivalent to 75,
100, 125 or 150 mg. of imipramine hydrochloride.)

(B) 98-146-840-A(9/75) 667120

For complete details, including dosage and adminis-
tration, please refer to the full prescribing informa-
tion.

GEIGY Pharmaceuticals
Division of CIBA-GEIGY Corporation
Ardsley, New York 10502

SA 11472

THE MARYLAND PHARMACIST

editorial

ey

Third Party Programs —
Priorities and Strategies

Prescription insurance or third party programs play a crucial
role in the professional and economic aspects of pharmacy
practice and management. Medicaid covers approximately 10%
of the total population and this percentage holds true in Mary-
land. For many pharmacies Medicaid prescriptions constitute
the major portion of their pharmacy service. A total of 25 to 50%
total third party practice — governmental and non-
governmental — already prevails for most pharmacies today, at
least in the independent pharmacy sector.

Obviously, then, the rules and regulations and remuneration
of any major third party program will influence the policies of
the others. If pharmacists are willing to accept certain condi-
tions and compensation from one third party program, they
cannot expect another program — whether Medicaid or a pri-
vate — to grant more favorable policies or more ‘‘equitable”’
fees.

Pharmacists and the management of pharmacies must face
these facts and make their decisions as to which programs they
can participate in without cutting their own economic and pro-
fessional throats in regard to obtaining equitable policies as to
the basis of cost of drugs and as to fee schedules.

Pharmacy cannot expect its state and national associations to
fight effectively for improved policies and methods of compen-
sation for Medicaid or some private plans when so many in
pharmacy find it possible, or even competitively necessary, to
charge the general public substantially less for their services.

Those who would use the profession of pharmacy as a loss
leader to entice customers to buy their high profit front mer-
chandise, such as sundries, hardware and clothing to name a
few lines, cannot expect to be subsidized at higher fees for
Medicaid or other plans. At the same time, of course, there
should be an administrative fee included for the additional
expense in the dispensing, use of forms, massive record keep-
ing and long outstanding accounts receivable involved in third
party prescriptions.

What Are The Priorities In Achieving Equitable Policies And
Compensation For Professional Pharmaceutical Services?

1. Professional services must be delineated through the de-
velopment and adoption of Standards of Practice. MPhA is
deeply involved in this process right now.

2. Pharmacy services in accordance with Standards of Prac-
tice adopted by the profession must be recognized by the pub-
lic and especially by decision makers as an absolute necessity
for comprehensive, effective and economical health care. This
can result from a planned educational and public relations pro-
cess by all elements of the profession sparkplugged by MPhA.

AUGUST, 1976

3. Both the general public as well as third party programs will
allocate their funds accordingly, if they perceive that patient
oriented (‘‘clinical’’) pharmacy services are an integral part of
health care. The goal must be the perception of an equation in
health care that cannot balance out without the kind of phar-
macy suggested here, with the accompanying public and private
budgeting required for implementation.

The use of pharmacy or a ‘pharmacy department’ as a pro-
motional gimmick or tool to create and sustain customer traffic
for “front merchandise’”’ would not be able to continue if in
conflict with the standards of practice characterized by per-
sonalized, patient oriented pharmacy. At the same time, the
realities of financing health care dictate the use of the latest
knowledge and techniques in dispensing, management,
equipment, electric data processing and use of different kinds
of ancillary personnel to assist the pharmacist.

Support of efforts organized through MPhA for a sophisti-
cated strategy, intelligent planning, socioeconomic research,
legislative representation, advocacy before government and
private agencies and political action — is needed to provide the
muscle to advance the legitimate aspirations of pharmacists.

Nathan |. Gruz

Ealencdex

November 4 (Thursday) — MPhA Simon Solomon
Pharmacy Economics Seminar, Quality Inn,
Towson

November 17 (Wednesday) — Upper Bay
Pharmaceutical Association Meeting

November 18 (Thursday) — Baltimore Metropolitan
Pharmaceutical Association Annual Meeting

November 18 (Thursday) — First Balassone Memorial
Lecture

November 21 (Sunday) — Pharmacy Bicentennial
Dinner-Dance, Martin’s West, Baltimore
Beltway at Security Blvd.

1977

January 14-21 — MPhA Seminar and Tour —
Acapulco and Mexico City
March 5-13 — MPhA Trip to Vail, Colorado

April 14 (Thursday) — MPhA Spring Regional and
House of Delegates Meeting

May 15-19 — APhA Convention, New York City

maryland board
of elnarinacy

NEW APPOINTMENTS

Bernard B. Lachman, R.Ph., past president of the Maryland
Pharmaceutical Association (1972-73), has been appointed to
the Maryland Board of Pharmacy. Mr. Lachman has been active
in association work for over a decade. In addition to previously
being elected Vice President and President of Baltimore Met-
ropolitan Pharmaceutical Association, Mr. Lachman has served
on the Public Relations, Legislative, Health and Welfare, Budget
and Finance Committees, and was President and Chairman of
the Board of Trustees of Maryland Pharmaceutical Association.
He has held appointments to the Pharmacy Advisory Committee
to Maryland Blue Cross and to the Governor’s Commission on
Crime and Dangerous Drugs. Mr. Lachman was an organizer of
PHARMPAC and has served on the State Medical Assistance
Advisory Committee. A 1945 graduate of the University of Mary-
land School of Pharmacy, and recipient of the Order of the
Double Star from AZO Pharmaceutical Fraternity, he operates a
community pharmacy in partnership with his brother, Marc
Lachman.

Bernard Lachman, a native of Baltimore, resides in Pikesville
with his wife Selma. They have three children.

Estelle G. Cohen, M.S., of Baltimore has been appointed to
the consumer position on the Maryland Board of Pharmacy.
Being the first to fill such a position, she brings much expe-
rience in the field of consumer economics. Mrs. Cohen is a
graduate of the College of Notre Dame of Maryland, and re-
ceived her Master’s Degree in Economics from the University of
Maryland in 1972. She co-chaired the conference for consumer
specialists given by the Federal Executive Board and the Con-

BERNARD B. LACHMAN

ESTELLE G. COHEN

sumer Crunch Conference hosted by Notre Dame College a:
part of a grant given to Dundalk Community College. Mrs|
Cohen has been instrumental in acquiring numerous state ane
federal grants for Notre Dame, among them a Carnegie Grant tc
implement the Consumer Economics Program she helped de.
sign. This expertise has made Mrs. Cohen a much sought after
guest lecturer, speaking at the National Democratic Women’s
Clubs of Maryland, Maryland Pharmaceutical Association and
others. She is currently an Assistant Professor in Economics and
Chairman of the Consumer Economics Program at the College
of Notre Dame.

Mrs. Cohen and her husband Alan K. Cohen are residents of
Baltimore and are the parents of 4 children.

Leonard J. DeMino, R.Ph., has been appointed to the Mary-
land Board of Pharmacy. He received his B.S. degree in Phar-
macy in 1956 from George Washington University. Since that
time he has worked for Peoples Drug Stores, Inc. in numerous
capacities until 1972 when he was appointed to his current
position as Director of Professional Services for Peoples. He
holds membership in District of Columbia, Pennsylvania, North
Carolina, Virginia and Maryland state pharmaceutical organiza-
tions and is a member of APhA and National Association of
Chain Drug Stores. Mr. DeMino’s involvement for pharmacy
ranges from local to national. His efforts include membership
on the Executive Committee of the Washington, D.C., Phar-
maceutical Association, Board of Trustees of the Maryland
Pharmaceutical Association, Chain Store Advisory Board of the
Roche Pharmaceutical Company and the Drug and Insurance
Industries Ad Hoc Committee to study third party problems.

Mr. DeMino received the A. H. Robins Bowl of Hygeia Award
for Community Service in Pharmacy from the D. C. Pharmaceut-
ical Association in 1972.

Mr. and Mrs. Leonard DeMino reside in Montgomery County
with their twin fifteen-year-old son and daughter.

LEONARD J. DeMINO

THE MARYLAND PHARMACIST

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d Ydrochtori

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Presenting a broad line of Unit-Dose and Unit-of-Issue packaging,
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In contrast to “count and pour” both packaging systems achieve
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Lederle Pharma-Flex System.

Name

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Address
City State Zip

218-5-Yr

CHARLES E. SPIGELMIRE
A PHARMACIST OF DISTINCTION

|Remarks of Nathan |. Gruz, Executive Director of the Maryland and
|Baltimore Metropolitan Pharmaceutical Association, upon the pres-
entation of the Honored Alumnus Award of the Alumni Association of
the University of Maryland School of Pharmacy to Charles E. Spigelmire
at the Annual Graduation Banquet, Eudowood Gardens, Baltimore —
June 2, 1976.

It is my great privilege and personal pleasure to participate in
a ceremony which embodies a three-fold honor.

First and second, in honoring Charles E. Spigelmire as the
Honored Alumnus of 1976, the Alumni Association of the Uni-
versity of Maryland School of Pharmacy has honored itself.
Thirdly, | feel deeply honored to have been selected by the
honoree to present the honored alumnus award. | am grateful,
‘Charles.

| would like to entitle my remarks: A Tribute To Charles E.
Spigelmire — A Pharmacist of Distinction.

At rare intervals in one’s personal and professional life, one
‘may be fortunate to know and work closely with a person who
makes a difference in the lives he touches — an unforgettable
person.

The life record of Charles E. Spigelmire is the history of a
person who has always been deeply devoted to his family, to his
faith and to his profession.

He was born in Edgewood, Pennsylvania, a suburb of
Pittsburgh, and is a graduate of Loyola High School in Baltimore.
He received his Ph.G. in 1929 from the School of Pharmacy,
University of Maryland.

Mr. Spigelmire joined his professional societies, was im-
mediately recognized as a doer and appointed to various com-
mittees over the years. His energy, enthusiasm and leadership
qualities soon resulted in his appointment as a committee
chairman and officer.

He is a Baltimore pharmacist who has been Chairman of the
Public Relations Committee of the Maryland Pharmaceutical
Association since 1954. During these years, he has also served as
Publicity Chairman for the Baltimore Metropolitan Pharmaceut-
ical Association.

On behalf of the Maryland Pharmaceutical Association, Mr.
Spigelmire for eight years conducted the “Best Neighbor’
weekly television series which portrayed the professional back-
ground and activities of pharmacists. At the present time, he
plans, produces and moderates MPhA’s radio program, “Your
Best Neighbor’ on WCAO-AM and FM. He has been involved in
this public service broadcast since November 22, 1959. This
public relations project includes presentations on pharmacy,
medicine and public health. Many prominent guests in other
health fields are featured in addition to leaders in pharmacy.

Other public relations efforts of Mr. Spigelmire have been
with radio stations WFBR, WITH and WBMD for both the Mary-
land and the Baltimore Associations. He has also been a leader
in the Association programs concerned with inter-professional
relations and exhibits, Diabetes Detection Week, Poison Pre-
vention Week, National Pharmacy Week, and both the Mary-
land and Baltimore City Health Departments. He actively pro-
moted the concept of pharmacies as ‘Health Information Cen-

AUGUST, 1976

ters’ and espoused the installation of racks made available by
the MPhA.

Mr. Spigelmire also devoted considerable effort and time to
MPhA and BMPA membership committee activities and has
been the sparkplug for the BMPA Annual Installation Banquet
fora dozen years. He has been designated as Grand Marshal for
both the MPhA, BMPA and Alumni Association for their Annual
Banquets. Time after time he has been honored and has in turn
honored pharmaceutical associations in response to requests to
serve as Installation Officer for incoming leaders.

He finds time to give talks with slides and exhibits of drugs
and chemicals to civic, PTA and fraternal groups on “Accidental
Poisoning in the Home.”’

In recent years when the necessity for a potent political action
arm to back up the efforts of the state association became
apparent it was not long before good old Charlie was the treas-
urer for PHARMPAC — The Pharmacists Political Committee of
Maryland. His dedicated efforts night and day achieved magnif-
icent results.

As tokens of the high regard and esteem of his colleagues,
Charles Spigelmire has acquired an enviable, but justly de-
served, unparalleled list of distinctions.

First, for his devoted service, the Maryland Pharmaceutical
Association in 1968 elected him Honorary President after he
repeatedly turned down opportunities to serve as president of
the state professional pharmaceutical society.

This Alumni Association elected him its Honorary President in
1969.

The Maryland Pharmaceutical Association in 1971 selected
him for the Bowl of Hygeia Award for professional and commu-
nity service.

This year at the Baltimore Metropolitan Pharmceutical Asso-
ciation Installation Dinner, he received the first Annual AID
Drug Service Award in recognition of his outstanding contribu-
tions to pharmacy in Maryland.

Mr. Spigelmire is amember of both the Maryland Council and
the Charles Carroll of Carrollton Fourth Degree Assembly,
Knights of Columbus in Maryland. He also belongs to the Alcala
Caravan of the Alhambra and the Holy Name Scciety.

He is amember of the American Pharmaceutical Association,
the National Association of Retail Druggists and was elected a
Vice President of the Maryland Academy of Medicine and
Surgery.

Charles Spigelmire is married to the former Josephine
Kaminski and they have three children: Charles Ill, with the
Department of Agriculture, Bureau of Rural Electrification;
Mary Jo, anurse, married to Dr. Joseph j. Tecce, a psychologist
in Boston; and Michael, aLt. Col. in the United States Army who
is On maneuvers in Germany. The Spigelmires have seven
grandchildren.

Mrs. Spigelmire is equally devoted to pharmacy and has
served as an officer of the Ladies Auxiliary of the MPhA
(LAMPA). In all fairness, we must pay a tribute to Jo, for without
her solid backing, assistance, understanding and patience,
Charlie could never have achieved his remarkable record as
Maryland’s Pharmacist of Distinction.

(Continued on Page 19)

17

94th ANNUAL CONVENTION |
MARYLAND PHARMACEUTICAL ASSOCIATION
SHERATON FONTAINEBLEAU INN, OCEAN CITY, MD.
JUNE 20-23, 1976

SUNDAY — JUNE 20

Registration was opened by TAMPA, the Travelers Auxiliary of
the Maryland Pharmaceutical Association, at 12 noon. The first
function, a cocktail party reception for all registered, was held
from 9:30 P.M. to midnight with music provided by William F.
Brown of Geigy.

MONDAY — JUNE 21

The opening General Session was convened by President
Henry G. Seidman at 9:00 A.M. Convention Chairman Ronald
Lubman outlined the convention schedule and social and rec-
reational events. |. Earl Kerpelman, past President MPhA, was
appointed parliamentarian.

President Seidman then called upon the representatives of
the various affiliated and related organizations to bring greet-
ings. The following responded: For Baltimore Metropolitan
Pharmaceutical Association, Ronald Lubman, President;
Allegany-Garrett County Pharmaceutical Association, Ernest
Gregg, President; Eastern Shore Pharmaceutical Society,
Gerald Overbeck, President, who expressed his best wishes
and welcomed all to the Eastern Shore; Upper Bay Pharmaceut-
ical Association, Charles Bernard and Student APhA-MPhA
Chapter, Margi Brophy, President.

President Seidman then recognized past MPhA President Vic-
tor H. Morgenroth, Jr. as the recipient of an Honorary Doctor of
Science Degree from the Massachusetts College of Pharmacy
for his many contributions to the profession, including most
recently, his service on the “Millis” Study Commission on
Pharmacy.

Normand Pelissier, past President of the Maryland Society of
Hospital Pharmacists and delegate of the MSHP, then spoke of
the benefits to the profession from the scheduling of MPhA and
MSHP meetings consecutively and at the same site.

President Seidman then called upon President-elect Melvin
N. Rubin to take the chair. Mr. Rubin then presented President
Seidman to deliver the President’s address. (The complete ad-
dress of President Seidman is printed in the July issue.)

The Chair was then returned to President Seidman who called
upon Paul Freiman, Chairman of the Board of Trustees. Mr.
Freiman stated that while the attendance of most of the officers
and trustees was excellent there should be some provision for
replacement of a Trustee for excessive absenteeism. He also
recommended the amendment of the By-Laws to provide for a
one year seat on the Board of Trustees for the President of the
Joint SAPhA-MPhA Chapter.

Report of the Treasurer Morris Lindenbaum. The annual re-
port prepared by the Certified Public Accountant had been
previously distributed to the delegates and was accepted on
motion duly made and seconded.

72

Report of the Executive Director Nathan I. Gruz. Mr. Gruz
spoke briefly of the challenges during the past year and the
response of the Association, especially in the area of legislation
and Medicaid. He pointed out the necessity for each member tc
serve as amembership recruiter, thereby enlisting all pharma.
cists to carry the financial load in proper representation of
pharmacy. The priority must be greater membership so that
MPhA can speak for the largest possible number of pharmacists
throughout the state as the representative state professional
society. He urged every member to enroll at least one new
member during the coming months. Mr. Gruz invited all pres-
ent to submit questions about any matter. There being no ques-
tions, the report was accepted.

Report of the Board of Pharmacy — Robert E. Snyder, Secre-
tary. Mr. Snyder presented a copy of the official report of the
Board of Pharmacy for 1975-76 in accordance with Section 258
of Article 43 of the Annotated Code of Maryland. A complete
report will be published in The Maryland Pharmacist. Mr.
Snyder announced the election of Frank Block by the Board as
Honorary President of the Board of Pharmacy, the appointment
of Bernard B. Lachman as the new member of the Board of
Pharmacy, succeeding Morris Yaffe and the election of |. Earl
Kerpelman as the new President of the Board of Pharmacy for
1975-76.

Mr. Snyder reviewed the highlights of the report of the Board
of Pharmacy. In a question and answer period, there was refer-
ence to the fact that there were many more hospital pharmacies
licensed this year than the previous year and there was a ques-
tion regarding the number of hospital pharmacies in Maryland
remaining unlicensed at this time. There was also inquiry as to
whether pharmacies in HMOs were considered community or
hospital pharmacies.

Report of Legal Counsel Joseph S. Kaufman. Mr. Kaufman
spoke of the main provisions and effects of the U. S. Supreme
Court decision on prescription price advertising which was
issued May 24, 1976. He also spoke of the court decision involv-
ing the Portland Retail Druggists Association on the issue of
differential prices charged by manufacturers to non-profit in-
stitutions such as hospitals. Mr. Kaufman also referred to the
case of pharmacists in the District of Columbia involved in
improper dispensing of controlled dangerous substances.
There was discussion regarding the Federal Trade Commis-
sion’s attitude in not vigorously upholding the Robinson-
Patman Act. The problem of physician violations of drug en-
forcement registration was also brought up.

School of Pharmacy Report — Dr. Dean Leavitt, delegate from
the School of Pharmacy, spoke briefly of the establishment of a
pharmacist placement service at the school. The matter of the
School of Pharmacy Task Force on the professional program was
brought up. The need for further opportunities for input from

THE MARYLAND PHARMACIST

the Maryland Pharmaceutical Association on behalf of the prac-
titioners was emphasized. The opening General Session was
concluded and recessed until 9:00 A.M. Tuesday.

HOUSE OF DELEGATES

Speaker Kamenetz convened the first session of delegates at
10:45 A.M. Secretary Nathan I. Gruz announced a quorum of
the House was present. The Speaker appointed |. Earl Kerpel-
‘man as parliamentarian of the House. He then called for com-
mittee and other reports.

1. Finance Committee — Stanley J. Yaffe, Chairman. The Com-
mittee met several times during the past year to review the
financial status of the Association and develop the budget for
1976. For 1975, income was $72,697 ($73,200 had been pro-
jected in the budget) and expenses were $71,080 ($70,000 had
been budgeted). The budget for 1976 had been set as $77,500
with expenses the same. So far this year expenses are going
as anticipated, but revenues will fall short. Although dues
collections are in advance of the same time last year, 1977
dues income which is received in November and December
of this year will have to be drawn upon again.

The Convention should produce in contributions and fees

the anticipated income, but our trip income for 1976 will be

lower than projected. The employment of an assistant for

The Maryland Pharmacist is an added expense, but bringing

the publication to a current basis will still not give us the full

amount that was budgeted. Printing costs, all overhead and
postage are rising expenses.

The Committee is working on all possible revenue sources,

but the major source is and must be from membership dues.

To meet our budgetary needs the Board of Trustees ap-

proved the following Committee recommendation for 1977:

Pharmacist dues — from $40 to $50.00; Owner’s pharmacy

fee — from $60.00 to $70.00. Thus the owner will pay $120

MPhA dues in 1977. Increased membership and dues income

is a must. | would like to thank all of the committee members

for their help in planning.

Because of the need for more money in the Kelly Fund

following renovation of the building $2.00 earmarked for the

Kelly Fund should be added to dues.

Mr. Yaffe moved for the addition of $2.00 to the 1977 dues for

one year only for allocation to the Kelly Memorial Fund only.

Seconded by Mr. Parker and passed.

2. Public Relations Committee — Charles E. Spigelmire, Chair-
man. A comprehensive report of public relations activities
for the year was presented.

The reports of the Finance and Public Relations Committees
were accepted.

3. Legislative Committee — Richard Parker, Chairman. A re-
view of the activity of the Legislative Committee since the last
Annual Convention covers many important areas of concern
to pharmacists. Among these are Continuing Education,
Drug Product Selection, Patient Medication Profiles, Pre-
scription Price Advertising, Board of Pharmacy composition
and regulations and other issues of local or allied group
importance.

Your Association worked actively with the legislature in pre-
paring bills which would be favorable to the good practice of

AUGUST, 1976

pharmacy and campaigned extensively against those which
were unwise or detrimental to the profession. We have
gained recognition as a force to be considered in all such
legislation and have the attentive ear of many delegations.
Your Committee has worked with Delegate Torrey Brown on
such important national concerns as Drug Product Selection
and Mandatory Continuing Education. As you know, these
bills were not passed in the 1976 General Assembly, but are
still being considered for the next Assembly as critical legisla-
tion. In the area of Mandatory Patient Medication Profiles,
our influence was felt to the extent that Delegate Timothy
Hickman contacted the Chairman of the Board of Trustees
for input into his proposed legislation. Delegate Hickman
was Invited to our Regional Meeting and made a presentation
which was so convincing of his dedication to this bill, that
MPhA House of Delegates voted to support his bill. The bill
subsequently was defeated in favor of the Board of Pharmacy
implementing regulations which would establish the main-
tenance of medication profiles as a standard of practice.

It is worthwhile to note at this point that the Committee on
Standards of Practice has drafted a proposal of standards for
patient profiles which was approved by the Board of
Trustees. This committee has been very active and has rec-
ommended the establishment by the Maryland Pharma-
ceutical Association of standards for credits to be issued for
Continuing Education and issuance of certificate for satisfac-
tory completion of requirements. This procedure would en-
able the adoption of standards acceptable to the Board of
Pharmacy in the event legislation is not forthcoming to re-
quire certification.

Legislation which has a direct impact on pharmacy failed in
most cases to pass in this session. The most significant of
those which were enacted into law is the change in composi-
tion of the Board of Pharmacy. HB 596 will increase the
membership of the Board by two members. One of these will
be a pharmacist and the other will be a public (consumer)
member. Of the bills which we were successful in defeating,
the ones affecting price advertising and establishing a Board
of Certification of Orthotists and Prosthetists were the most
important. Since the General Assembly session however, the
Supreme Court has invalidated restrictions on price advertis-
ing of prescription drugs and it most certainly casts doubt on
Maryland’s restrictions. We will also will be faced with a
renewed attempt to establish a Board of Certification of
Orthotists and Prostetists in the next session, since this was
referred to Legislative Council for study. For a more com-
prehensive report on legislative action for the past year, |
refer you to the Newsletter of the Maryland Pharmaceutical
Association which President-elect Melvin Rubin so capably
handles. The April 1976 issue contains a summary of bills
affecting the profession.

In looking to the future, the Legislative Committee wel-
comes the support and advice of all members. We plan to
continue working for Drug Product Selection, Continuing
Education, “Freedom of Choice” in HMO plans, funding for
the Board of Pharmacy and the professional image of phar-
macy. It is apparent from the ruling of Chief Justice Warren
Burger that the professional status of pharmacy will only be
established when we can clearly demonstrate the consultant

13

uw

14

and clinical aspect which is being currently taught in our
schools. Continuing Education is a necessary adjunct to that
training.

The report was accepted.

. Prescription Insurance Committee — Marvin Friedman,

Chairman. Mr. Friedman gave a brief outline and stated that
the full report which was distributed in the delegates’ kits
would be considered at the Tuesday session of the House.
He thanked the committee members for their assistance and
contributions.

Membership Committee — Elwin Alpern, Chairman. Mr.
Alpern presented a written report. During 1975-76 the
Committee met several times to plan and carry out a mem-
bership campaign. A $76 dues was set up On a One-time basis
for new members (reinstatements were not eligible). A goal
of 200 members was set for the Bicentennial Year. Over 80
new members have been enrolled so far this year.

At the end of 1975, we had 755 members. So far this year, we
have 726 dues paid compared to 630 the same time last year
(1975) and 570 in 1974.

We began a drive to get each local to work on their area. This
effort must be intensified. We hope that the number of
hospital pharmacists will continue to increase. The number
of pledges (graduates) and other pharmacists who have
graduated in the past 5 years has continued to grow. At the
end of 1975, we had 98 pledges. Today we already have 105.

We hope to redouble our efforts to organize local member-

ship committees and to get every possible pharmacist —
employee, hospital, chain, independent, faculty, govern-)
ment or whatever, to enroll. Ifevery member will get just one |
new member between now and December, we will solve
many of our organizational and financial problems.

| would like to thank all the members of my committee. My
personal thanks to Charlie Spigelmire for his usual fantastic
efforts in our behalf. Any questions? Any suggestions, please
feel free to see me.

The report was accepted.

6. Newsletter Committee — Melvin Rubin, Chairman. The

Newsletter has grown in stature, acceptance and appearance
in the past year and can now be considered as one of the
advantages of membership in MPhA. It has been used as
recruitment tool. Thanks again go to Mr. Nathan Gruz for the
editing and Ms. Carol Yarsky for her work on typing and
format.

An area which still needs improvement is in reporting local
association work. Local news brought to the staff’s attention
by the 20th of the month is used whenever possible. Use the
Newsletter for additional notice of meetings and to inform
other members of activities.

. Pharmacy Practices Committee — Melvin N. Rubin, Chair-

man. The House of Delegates approved our position on
‘Pharmacist Responsibility and Reserved for Pharmacist

(Continued on Page 17)

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Only”, proposed Pharmacist-in-Charge regulations, and a
mechanism to allow pharmacists to transmit copies of pre-
scriptions to another pharmacist. These areas are still being
considered by the State Board of Pharmacy for enabling
regulations. The Board of Trustees approved an MPhA policy
of Patient Medication Profiles.

The Committee began consideration of standards for certifi-
cation of pharmacists who have attained proper total of con-
tinuing education credits on a voluntary basis and standards
for certification of pharmacies who have proven that they
maintain and utilize patient profiles.

Since these two projects represent policy decisions with a
great potential for affecting the standard of practice of the
profession, approval is being requested of the House of
Delegates at this Convention.

Upon motion of Mr. Rubin, duly seconded, the report was
approved.

8. Convention & Trips — Ronald Lubman, Chairman. Mr. Lub-
man announced plans for various forthcoming trips includ-
ing the NARD Convention in San Francisco in September and
a trip to Mexico in January. Arrangements are also being
worked on in connection with the APhA Convention in New
York in April. He announced a fund raising affair on July 22 at
the Burn Brae Dinner Theater on behalf of PHARMPAC.

9. Peer Review Committee — Irvin Kamenetz, Chairman. Peer
Review Committee Annual Report.

The first session of the House of Delegates adjourned at 12:30
P.M.

MPhA, TAMPA and LAMPA members then joined attendance
at the convention bicentennial feature, ‘The Apothecary and
the Practice of Medicine in Colonial Times” — Lecture and slide
presentation by Morris L. Cooper, Curator MPhA Cole Phar-
macy Museum. A most informative and enlightening program
presented in an excellent manner was enjoyed by all.

Adjournment was at 1:30 P.M.

At 6:30 P.M. all members of MPhA, TAMPA, LAMPA and their
guests gathered for a crab feast at the Berlin Fire Hall. The
evening was concluded with a square dance sponsored by
TAMPA.

Tuesday Morning at 8:00 A.M. a breakfast was sponsored by
Maryland members of the American College of Apothecaries
chaired by Joseph U. Dorsch. Speakers included: A.C.A. fel-
lows Nathan |. Gruz and Victor H. Morgenroth, Jr. The objec-
tives, history and services of ACA were outlined. The many
contributions of ACA to professional progress were presented
and membership brochures distributed. There is a joint
Maryland-Virginia Chapter of ACA. Itis planned to continue the
breakfast as an annual event at the MPhA convention.

TUESDAY — JUNE 22

Second General Session was convened at 9:00 A.M. by Presi-
dent Seidman who recognized Donald O. Fedder, past Presi-
dent of MPhA, who has been designated Chairman of the Board
of Trustees of the American Pharmaceutical Association for
1976-77.

Memorial Service — The memorial prayer was ready by
Gerald Overbeck of Salisbury. The Necrology was then read by

AUGUST, 1976

Robert E. Snyder of Baltimore, MPhA Trustee and Secretary of
the Board of Pharmacy.

Morton Arbanel

Aaron Abramson

Israel Baker

Joseph Belford

George Black

Charlotte Bosch Schollech
Sister Mary Carmel Clarke
Benjamin Chester Cwalina
Michael Dausch

Harold T. Derry

Frank Dingus

Sidney Herbert Flom
Samuel Lewis Fox

Harry Joel Goldberg
Sylvan Goodman

Ernest Helgert

George Karman

Maxwell Alvin Krucoff
Irvin Kemick

Frank Ferdinand Levay
Norman J. Levin
Benedict Casimir Malinowski
Keith L. Morrish

Jerome Pinerman
Gifford Le Grand Potts
Dexter Reinmann
Raymond C. Robinson
Demitrious Rodriguez
Elbert William Schotta
Morris Shenker

Isidore Irvin Small (ovitz)
Jerome Snyder

Simon Solomon

Isaac Standiford

Edward Charles Vojik
Raphael Hyman Wagner
William Weltner

The service concluded with the reading of Psalm 23 by
Nathaniel Futeral of Baltimore.

The House of Delegates then convened its Final Session with
Speaker Kamenitz presiding.

Secretary Gruz announced that Delegate Carter Hickman of
Worcester County, where Ocean City is located, was the only
Eastern Shore legislator present at the crab feast the previous
evening. While many legislators expressed a deep appreciation
for our invitation, prior commitments prevented their
attending.

The minutes of the regional meeting of April 29, 1976 previ-
ously distributed in the delegates’ kits were approved with the
following corrections. Under New Business, the motion to table
was made by SAPhA delegate Bonnie Levin and Item #11 was
tabled due to lack of quorum.

Prescription Insurance Committee — Marvin Friedman,
Chairman. The comprehensive report with attached table out-
lining the provisions of various third party programs was
reviewed. Amemorandum from James C. Eshelman, Director of
the Medical Assistance Policy Administration, dated June 7, 1976
on proposed pharmacy regulations was received at the Associa-
tion office on June 18 and was included in the delegates’ kits.
Mr. Friedman reviewed the regulations and the memo of Mr.
Eshelman. There were questions regarding the validity of the
interpretations of the regulations included in the memo. The
report was approved, but as the SAPhA-MPhA delegates indi-
cated objection to the reference to HMOs on page 3 of the
report, the following motion was then made: Mr. Friedman
moved for an addendum reflecting the view of SAPhA to em-
phasize the professional factors of pharmacy services and
patient care.

UNFINISHED BUSINESS

1A. Health Maintenance Organizations — The motion of
Donald Schumer at the Spring Regional Meeting on the
subject of HMOs was broken into two parts. Mr. Schumer
moved first that MPhA support a ‘‘freedom of choice” of
pharmacy policy for HMOs and for the enforcement of
“freedom of choice” of outside pharmaceutical services
providers for HMOs. Seconded and passed.

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1B. Mr. Schumer then moved that MPhA supports and works

toward a program whereby the state would be responsible
for direct payment to pharmacies for services provided in
good faith for patients of HMOs.

. Liquor Licenses in Pharmacies — Motion tabled from

Spring Regional Meeting: “In order to raise the profes-
sional image of pharmacy, MPhA go on record as opposing
the issuance of new alcoholic beverage licenses in phar-
macies in the State of Maryland. The Association shall not
oppose the renewal of nor the transfer of licenses that are
now in effect.’ Delegates from SAPhA-MPhA Chapter
asserted that MPhA should take a stand against all liquor
sales in pharmacies. The original motion did not receive a
majority and failed.

. Paid Prescription Audits — Item #11 from Spring Regional

Meeting Minutes. Mr. Rubin moved “that Paid Prescrip-
tions Incorporated be contacted in connection with their
audits to determine what the basis is for their action in
billing their participating pharmacies for alleged dif-
ferences in cost of drugs from various sources.” Mr. Rubin
moved for adoption of the motion. Seconded and passed.

NEW BUSINESS

iP

Mr. Sandel moved for a detailed agenda to be mailed thirty
days prior to the annual and regional meetings. Seconded
and passed.

2. Mr. Freiman moved for commendation of the following

18

members of the MPhA Committee on Medicaid for their

outstanding report: Marvin Friedman, Chairman; Melvin
Rubin, Ron Sanford and Gerald Freedenberg.

. A proposal by Donald Schumer for a campaign to enroll

representatives of manufacturers and suppliers as associate
members was referred to the Industry Relations Commit-
tee?

. On behalf of the BMPA, its President Ronald Lubman

moved that the State Board of Pharmacy be urged to take all
appropriate steps for enforcement of the law requiring leg-
ible physician names and dating on prescriptions and for
monitoring use of the abbreviation of PRN. Seconded and
passed.

. Mr. Freiman moved for endorsement of an amendment of

the Constitution By-Laws to add a seat on the Board of
Trustees for representative of the Joint SAPhA-MPhA
Chapter. Seconded and passed.

. Mr. Morgenroth’s proposal for the State Department of

Health to require Rx forms to include imprinted provider
numbers on prescriptions was referred to the MPhA Medi-
caid Committee.

- Mr. Stanley Yaffe moved that the MPhA send a letter of

commendation to the third party prescription plan which in
the opinion of MPhA’s Third Party Prescription Programs
Committee most closely approximates the ideal plan (taking
into consideration all facets of operation) and that a copy of
this letter of commendation be sent to all of the other third
party plans operating in the state of Maryland as an indica-
tion of the MPhA assessment of the various programs.
Seconded and passed.

THE MARYLAND PHARMACIST

8. Mr. Rubin moved that the MPhA Spring Regional House of
Delegates Meeting be held before the annual APhA Con-
vention. Seconded and passed.

9. Board of Pharmacy — Immediate past President of the
Board of Pharmacy Morris Yaffe gave a history of the organi-
zational and funding problems of the Board. Division of
Drug Control personnel are no longer permitted to do
Board of Pharmacy work and Mr. Charles Tregoe, Chief,
Division of Drug Control, has resigned as Secretary of the
Board.

10. APhA and NARD relations —A proposal by Mr. Stanley Yaffe
that dues to these organizations be withheld pending closer
cooperation between the two groups was referred to a
committee to be specified by President Rubin.

11. Two year terms for officers — An amendment to the Con-
stitution and By-Laws by S. Ben Friedman to provide two
year terms for President, President-elect, Vice President,
Treasurer, Speaker and Vice Speaker was referred to the
Constitution and By-Laws Committee.

12. Mr. Rubin moved to commend Ronald Lubman and the
Convention Committee for an outstanding and successful
convention. Seconded and passed by acclamation.

13. Report of the Nominating Committee was given by Chair-

man Paul Freiman. The Nominating Committee met on May
20 and on June 10, 1976 and I am pleased to submit the
following slate of officers for approval for a mail ballot for
the 1977-78 term: President-elect: Edward Nussbaum,
Rockville and Richard D. Parker, Kensington; Vice Presi-
dent: Ben G. Owens, Annapolis and Stanley J. Yaffe, Oden-
ton; Treasurer: Anthony G. Padussis, Timonium; Trustees
(2 vacancies): 1st pair: Adolph Baer, Hagerstown and
Robert J. Martin, LaVale; 2nd pair: Vincent P. Burkhart,
Baltimore and Normand A. Pelissier, Joppatowne.
There being no further nominations from the floor, Mr. S.
Ben Friedman moved for adoption of the report. Seconded
and passed. The slate will be sent to members for a mail
ballot vote.

14. Board of Pharmacy Nominees — Mr. Freiman announced

the following nominees for the opening on the Board of
Pharmacy for a sixth pharmacist beginning in 1976: 1)
Leonard J. DeMino, 2) Stanley J. Yaffe and 3) Emanuel
Richman. Morris Yaffe nominated S. Ben Friedman for the
vacancy. Seconded. Mr. Friedman declined the nomina-
tion. Mr. Ernest Gregg moved for the nomination of Robert
J. Martin of LaVale but withdrew the nomination for sub-
mission for another vacancy.
Mr. Freiman announced the recommendation as consumer
representatives to a new vacancy on the Board of Pharmacy
the following : Mrs. Estelle Cohen, faculty member and
head of the Department of Consumer Affairs at Notre Dame
College in Baltimore and Mrs. Edna DeCoursey Johnson
with the Urban League in Baltimore. Both nominees have
been serving on the MPhA Pharmacy Consumer Affairs
Committee. The consensus was for approval of these rec-
ommendations.

For a vacancy on the Board in 1977 for the position of |. Ear!
Kerpelman: 1) Paul Freiman, 2) Victor H. Morgenroth and 3)

AUGUST, 1976

Anthony G. Padussis. Mr. Gregg moved for the nomination
of Robert J. Martin of LaVale, seconded. Mr. Truitt nomi-
nated Gerald Overbeck of Salisbury, seconded. Messrs.
Morgenroth and Padussis withdrew their names from
nomination. Stanley Yaffe moved for approval of Messrs.
Freiman, Martin and Overbeck. Seconded and passed.

Mr. Freiman presented the nominations of Irvin Kamenetz
as Speaker and Samuel Lichter as Vice Speaker, seconded.
Mr. Freedenberg moved for the nomination of Victor H.
Morgenroth as Speaker, seconded. On a closed ballot Mr.
Morgenroth was elected Speaker for 1976-77 and Mr.
Samuel Lichter as Vice Speaker. Mr. Freedenberg moved
for the election by unanimous vote of the Speaker of the
House.

Mail ballot for Board of Pharmacy Nominees — A proposal
by Mr. Lubman for mail ballot election of nominees for the
Board of Pharmacy referred to the Constitution and By-Laws
Committee.
Mr. Stanley J. Yaffe recommended that the 1977 Convention
be held in Ocean City, Md.
The Final Session of the House of Delegates adjourned at 1:00
P.M.

Following announcements concerning the installation ban-
quet dance in the evening, the tennis tournament and the
Continuing Education Program, the General Session of the
Maryland Pharmaceutical Association 94th Annual Meeting was
adjourned at 1:15 P.M.

Tuesday Evening — June 22. Cocktail Party and Annual Installa-
tion Banquet and Dance.

WEDNESDAY — JUNE 23

9:00 A.M. to 12:00 noon — Continuing Education Session —
Co-sponsored by APhA Academy of Pharmacy Practice. ‘’Un-
derstanding and Using Bioavailability Information: An Action
Seminar’”” Workshops conducted by Richard P. Penna and
William F. McGhan.

Charles E. Spigelmire (Continued from Page 11)

In reviewing the history of pharmacy in Maryland for the past
quarter of a century, | have been struck by the indispensable
contributions of this one person. This history indicates that here
was, and fortunately still is, one giant of a man — a man who
could always be relied on to respond to the needs of his and our
profession; a man for whom the advancement of pharmacy
through the united efforts of pharmacists working through their
pharmaceutical associations was an article of faith; a man who
was willing to work for the progress of pharmacy during his free
time — days, nights and holidays — as a labor of love. | gratefully
acknowledge my personal debt to you for your assistance and
dependability in all the many problems confronting pharmacy
that we have addressed over the years in association affairs.

Charles, it is a great honor to present this 1976 Honored
Alumnus Plaque to you on behalf of the Alumni Association of
the University of Maryland School of Pharmacy. We wish you
and Josephine many more years of health, happiness, good
fellowship and the joys of selfless service to your fellow men
and women.

19

COMMITTEE REPORTS

PRESCRIPTION INSURANCE
PROGRAMS
(THIRD PARTY Rx)

Marvin Friedman, Chairman

The scope of activity of the Third Party Committee for the year
1975-76 has not been limited to, but has focused primarily on
the problems and actions in the area of Medicaid. Continuous,
and hopefully fruitful meetings have taken place with the repre-
sentatives of the Department of Health and Mental Hygiene
(DHMH), members of the legislature, and the Association
membership itself so that the majority viewpoint could be care-
fully presented.

Initial proposals from HEW as to the implementation of a
Maximum Allowable Cost/Estimated Acquisition Cost (MAC/
EAC) program for State Medicaid payments were sent out in
September 1975. However, this development was quickly over-
shadowed in Maryland by the cutbacks in Medicaid services
under the misleading title of “Cost Containment’. One public
hearing was held on December 1, 1975 and the program was
implemented unchanged on January 1, 1976, instituting a 50¢
co-pay on each Medicaid prescription and eliminating all OTC
medication from the program (except insulin, insulin syringes,
and certain family planning supplies). Your Committee fought
these proposals from the time they were made public, including
a very pointed presentation by Executive Director Gruz at the
above mentioned public hearing, but to no avail. These restric-
tions are still with us and we will continue to explore the means
of modifying them or removing them altogether. Our ultimate
objective is, of course, the restitution of all services. Until that
can be achieved, we will work for an OTC Formulary concept
allowing certain classifications of OTC’s to be dispensed on
Medicaid and a step by step reduction in the CO-pay provision
until it is eliminated altogether.

In February 1976 DHMH announced, with no prior warning,
the institution of a new computer program to be applied to the
payment of all Medicaid invoices. This method of payment
would necessitate the insertion of maximum price levels for
each drug that is covered under the program into the computer,
which would then lower any prescriptions submitted with a
higher cost, whatever the reason. This in effect would have
meant a MAC/EAC program at the State level even if the Federal
guidelines were not ready by April 1, 1976 as Originally an-
nounced. Your Committee has vigorously opposed this con-
cept and we believe has achieved a fair measure of success. In
cooperation with PHARMPAC (Pharmacists Political Action
Committee), a strong campaign of opposition to any program
that would effectively lower the price base without concurrent
fee schedule adjustments and inflationary factor considerations
has been pursued. Legal counsel was engaged should the pos-
sibility of a court action arise. During the ensuing negotiations
with DHMH, his advice and cooperation has been invaluable.

The state’s present position on this program is one of indefi-
nite postponement or until the Federal program is instituted,
now scheduled for August 26, 1976. However, this date remains

20

|
|
questionable. Ifa price program is inserted into the computer, it /
is supposed to be AWP with a small exception list calling for
direct prices and/or quantity prices in few instances. This list
started with approximately 50 drugs and we have already been
successful in eliminating 50% of these.
Recap of Medicaid developments for the year:
1. Cost Containment — Association fought to eliminate co-pay
and exclusion of OTC medication. LOST

2. Committment by DHMH for advance notice to be given to
MPhA committee of any proposed changes in Medicaid regula-
tions and consideration of our positions on them. ACHIEVED

3. MPhA must have input on any price structure under MAC/
EAGZ ACHIEVED

4. Advance MAC Price List to be provided to all vendors before
implementation. State says it cannot do this; however, the
Committee is still pressing for this requirement.

5. System of parameters to safeguard against errors resulting in
under payments and a system to identify any lower prices on
remittance sheets. UNDER CONSIDERATION.

6. Accurate and regular (weekly if possible) update on price
changes. PROMISED

7. Continuing negotiations on equitable fee adjustment taking
into consideration alt of the following factors:

A. Increased paperwork on invoices

B. Payment within 30 days of submission of invoices

C. Increasing cost of supplies

D. Inflationary factors
- Accurate, valid survey to determine actual cost of filling

Rx.

The problems posed by the proliferation of HMO’s, primarily
within the Baltimore metropolitan area, were brought into
focus by the many problems encountered with Medicaid during
the past year. Due to the fact that these groups are still primarily
serving Medicaid patients, a severe impact on the prescription
volume was felt by those community and chain pharmacies who
have the bulk of their Rx practice in Medicaid prescriptions. The
Committee feels that we must continue to fight for “Freedom-
of-Choice”’ for enrollees in these HMO’s as far as their phar-
macy services are concerned. Along this line we have recom-
mended to the State that pharmacy services be dropped as part
of the capitation that each HMO receives under their yearly
contract with the State, thereby allowing patients to have their
prescriptions filled as in the past at the pharmacy of their choice
with the State paying the vendor directly on a fee-for-service
basis.

The most troublesome problem with HMO Rx’s has been the
nonpayment of invoices for Rxs filled in good faith on “Red-
White” Medicaid cards, when the patient has already enrolled
inan HMO. Pressure from the Committee and the threat of legal
action against both State and HMOs has gotten some results in
payment of these bills, but the problem is a continuing one. The
best concession from the State so far is that they will guarantee
payment for these Rxs, either by applying direct pressure on the
HMO to make payment or by removing funds from their
monthly capitation payment. However, at this time we only
have the State’s word on this.

m

The Committee would recommend that all members who
have strong feelings against the HMO concept in providing

THE MARYLAND PHARMACIST

pharmacy services convey these to all government officials who
would be concerned, playing on the theme of HMO’s driving
out of existence private professionals who pay the taxes that
help fund government programs.

The result of all our negotiations with the State are being
closely watched by the administrators of all third party plans

THIRD PARTY Rx PLANS

operating within the State. Your Committee feels there are
many areas in which these plans could improve and to that end
the attached chart has been prepared listing various strong and
weak points of each. The delegates may wish to make recom-
mendations based on these facts.

JUNE 1976

Payment
After

Plan Billing Pricing Policy Rejection Procedure Fee Claim Form
APS 30 days AWP paid; Loewy Drug Co. Minimal rejection rate; $2.00 Good; uses
_ (approx.) printout used © ; prompt reprocessing NDC Numbers
Blue Cross of = 14-21 AAC asked; will pay AWP Very minimal; will adjust $2.10 Good; no code
Maryland days if from wholesaler and prices up or down; numbers required
g ~~ i ifnoted on form reprocessing can be a problem
Construction 15 AWB pays; will pay Minimal; $1.85 Good; uses
Workers Trust days any reasonable charge will do price adjustments NDC Numbers
Fund and
Affiliated Funds
1199A Benefit 60-90 May accept AWP; Moderate; $2.00 | Most complicated
Fund days arbitrarily lowers prices reprocessing is generally prompt in use; should
ma eee iowevers) | 2 | VE Ae ea —_ be changed
Paid as 30-45 Will lower with no Moderate; does not return $1.85 “Fair’’; uses
Prescription days explanation; Rx form, but sends a to NDC Numbers;

rarely accepts AWP Claim Return Statement $2.10 should
0 LS eee ee that may be confusing 3 standardize more
ECS 45-60 AWP accepted; Moderate; does not return $1.85 ‘Fair’; has own
days will lower with no Rx form but sends a rejection to code numbers but
explanation however card that may be confusing $2.10 switching to NDC

ee __. See a oe ae pick could be improved
Prescription 45-75 Red Book prices used but Minimal; $1.95 Good; uses
Drugs, Inc. days makes little attempt to keep slow on reprocessing NDC Numbers
(PDI) up with increases; will
stC—CS—SCS arbitrarily lower many prices z .
Pharmaceutical 30 AWP accepted; Minimal $2.00 Good; uses

Services will correct errors
Foundation

(PSF)

days

“universal’’ form

PEER REVIEW COMMITTEE

Irvin Kamenetz, Chairman

The format regarding reported consumer complaints has
been most effective in practice during the past year. Each com-
plaint made against a pharmacy/pharmacist received a prompt
response. The impartial and complete investigation of the per-
tinent issues resulted in the ultimate satisfaction of everyone
concerned.

On a recent radio talk show the Maryland Pharmaceutical
Association was superbly represented by Paul Frieman and
Ronald Lubman. The phone number of the Maryland Phar-
maceutical Association was constantly mentioned and we an-
ticipated an avalanche of complaints; actually the response was
extremely favorable. Many inquiries were received regarding
pharmacy and other health agencies, as well as questions unre-
lated to pharmacy. The general feeling reflected the consumer's
satisfaction with his individual pharmacy and pharmacists.

AUGUST, 1976

The Peer Review Committee is planning additional publicity
to apprise the public of the pharmacist’s willingness to listen
(with a sympathetic ear) to any complaints.

This year the committee has referred Third Party problems to

other related committees.
(Continued on Page 23)

Schulz Joins MPhA Staff

Richard M. Schulz, a 1976 Graduate of University of Maryland
School of Pharmacy, is now in the employ of Maryland Pharma-
ceutical Association in the capacity of Assistant to the Director.
He was active in SAPhA and SCODAE during his school years at
Baltimore, and worked as an Officer at the Maryland Poison
Center during his fifth year. Mr. Schulz’ efforts at MPhA are to
center on the organization’s journal, The Maryland Pharmacist.
At present, he is also a practicing community pharmacist and
holds membership in APhA, MPhA, ASHP and MSHP.

21

A Sail Uh),

Maryland Pharmaceutical Association

94th ANNUAL CONVENTION

Sheraton Fontainebleau, Ocean City, Maryland
June 20-23

(Top row, left) Marvin A. Friedman, Chairman of the Prescription Insurance Program Committee, addresses the House of Delegates.

_ (Center) Outgoing President Henry G. Seidman receives the President's Plaque from Melvin N. Rubin, 1976-77 President. (Right)

Morris L. Cooper, Curator MPhA Cole Pharmacy Museum, presented a bicentennial feature, ‘The Apothecary and the Practice of
Medicine in Colonial Times.”

_ (Middle row, left) Robert E. Snyder speaking as Secretary of the Board of Pharmacy. (Center) Legal Counsel Joseph S. Kaufman

discusses recent court proceedings. (Right) Convention Chairman Ronald A. Lubman enjoying a casual moment with Charles E.

Spigelmire.

(Bottom row, left) Delegate Carter Hickman (seated far left) of Worcester County feasts on some Eastern Shore crabs with MPhA

convention goers. (Right) Irvin Kamenetz, Kenneth Mills, Anthony G. Padussis and Nathan |. Gruz share company at the cocktail

party.

(Continued from Page 21)

REPORT OF THE MARYLAND PHARMACY
TRIPARTITE COMMITTEE

Paul Freiman
MPHhA Representative

Though many pharmacists are not aware of its existence,
there has been functioning in Maryland for the last two years a
vital committee that will affect the practice of pharmacy in our
state. The committee is the Tripartite Committee and has repre-
sentatives from all the major organizations in pharmacy includ-
ing the Maryland Pharmaceutical Association, the Maryland
Society of Hospital Pharmacists, the Maryland State Board of
Pharmacy and the University of Maryland School of Pharmacy.
Its intent is to bring about acommon meeting ground to discuss
the many problems affecting our profession, and hopefully a
unified course of action to help solve these problems. Although
slow in beginning, this committee has now begun to function as
a vital force in helping to solve old problems and to develop new
ideas and goals for pharmacy in Maryland.

At the present time, two subcommittees are functioning
under the auspices of the Tripartite Committee. One committee
under the chairmanship of Paul Cuzmanes, a pharmacist and
lawyer, is working on a revision of the Maryland Pharmacy Law,
and another subcommittee under Donald Fedder has com-
pleted a project on the proper labeling of prescriptions. At a
meeting held on June 18, 1976, at the School of Pharmacy, a final
draft on “The Use of Auxiliary Labeling Systems for Providing
Patient Information” was presented and approved. This docu-
ment will be distributed to all pharmacists in Maryland and
through its utilization by all practitioners, hopefully will lead to
safer and more effective use of medication by all patients. At the
same meeting Mr. Cuzmanes reported that the first draft of the
revised pharmacy act should be ready by October at which time

AUGUST, 1976

it will be distributed for study and comment by all the organiza-
tions represented and their members.

In addition to the two subcommittee reports, the following
items were discussed at the June 18th meeting.

1. Holding of quarterly meetings of the Tripartite committee
with Donald Fedder serving as coordinator and secretary.

2. Patient profile systems — their utilization and whether they
should be made mandatory. This was as a result of recent
legislation introduced by Delegate Timothy Hickman to
mandate patient profiles. Recommendations to the Tripar-
tite Committee from the MPhA and other organizations will
be considered at the September meeting.

3. Pharmacist-in-Charge regulation — It was decided that the
Board should issue regulations requiring that each phar-
macy have a designated ‘‘pharmacist-in-charge” prior to
issuance of a permit.

4. Professional duties of a pharmacist — This was in response
to a position paper by the MPhA, approved by the MPhA
House of Delegates on October 29, 1975. This will be con-
sidered by the Board of Pharmacy for further action.

5. Posting — As a result of the recent case involving Philip P.
Weiner, it was felt that the Board of Pharmacy, before con-
cerning itself with new posters for 1977, should evaluate the
decision and how it affects the Maryland posting law.

6. Oral transmittal of copy of a prescription — As the MPhA
has suggested that the Board of Pharmacy promulgate regu-
lations on the legality of copies, it was felt that a position
paper by MPhA should be made available to the Board of
Pharmacy prior to the next meeting of the Tripartite Com-
mittee in September.

7. Legislation — It was felt that the Tripartite Committee could
serve as a clearing house for all proposed pharmacy legisla-
tion, so that we can go to Annapolis with a unified voice.

23

DRUG EVALUATION

IBUPROFEN — FURTHER EVALUATION

Thomas H. Wiser, Pharm.D.*

Ibuprofen (Motrin, UpJohn) is a recently marketed
nonsteroidal analgesic, antipyretic and anti-inflammatory (in
high doses) agent. An excellent drug evaluation article on ibu-
profen and its kinetics, side effects, precautions, administration
and review of clinical studies can be found in the March 1975
issue of The Maryland Pharmacist. The difficulty with evaluation
of ibuprofen prior to March 1975 was that clinical research
studies failed to document long term efficacy and safety espe-
cially at the higher dosage ranges of 1600-2400mg. These are key
issues in the evaluation of ibuprofen because it is recom-
mended for the long term treatment of two chronic diseases,
rheumatoid arthritis and osteoarthritis (degenerative joint dis-
ease). This report will address these two issues with emphasis
on data that has accumulated in the past two years.

EFFICACY

Blechman, Schmid, et al (1) performed a year long, double
blind multiclinic trial in 885 patients with rheumatoid arthritis
testing the use of ibuprofen and aspirin. Drug compliance was
measured by using serum assays of each drug. Efficacy was
determined by using specific predetermined end points with
regard to patients’ subjective improvement, physicians’ evalua-
tion of the disease, and grip strength. Endpoints for toxicity
Included: ESR; CBG, SGOT. creatinine, alkaline phosphatase,
platelet counts, uric acid and stool guaiac values at specific
intervals. These patients were on no other medicines at the time
of the study and the patients had ‘‘classical or definite’”’
rheumatoid arthritis (RA) according to American Rheumatism
Association criteria. Results showed a favorable and equal re-
sponse to both agents with fewer adverse reactions and drop
outs with ibuprofen. No serious adverse effects were reported.
The only fault with the article was lack of a cross-over and/or
control group design. The majority of patients on ibuprofen
received 800-1,600mg.

Hamatz, Rolstein, et al (2) compared ibuprofen and placebo
in 222 RA patients for a 6 month period using a double-blind
noncross-over design. Using appropriate predetermined
criteria for improvement based on history, physical findings and
laboratory data, ibuprofen demonstrated Statistically and clini-
cally significant improvement without serious adverse reactions
and only minor miscellaneous reactions. The dosage used was
1600mg.

Royer, Moxley, et al (3) compared the efficacy of ibuprofen
and indomethacin in a randomized, double-blind, six-month
study of 218 patients with RA. Appropriate predetermined
criteria for efficacy and toxicity were evaluated. The results
demonstrated efficacy in both treatment groups with a lower
degree of adverse reactions in the ibuprofen group. No serious
adverse reactions were reported. There was no cross-over de-
sign in this study. The dosage used was 1600 mg.

The above 3 studies and others (4), (5) have demonstrated
efficacy within each individual study. The best design of all the

24

clinical trials is not without fault, ie., no cross-over pattern or nc
placebo or control groups. The above references have judgec
ibuprofen as improving clinical symptoms and also judge it a:
equal to current standard aspirin and indomethacin regimens. |
has been demonstrated that ibuprofen is an efficacious drug
comparable to aspirin or indomethacin for long term therapy.

TOXICITY

In all of the references listed above (1), (2), (3), (4), (5), there
were no serious life threatening events that were reported.
Although most of these studies were 6 months to one year in
duration, the maximum dose was 1800mg. A review of 293 pa-
tients who had been treated with ibuprofen for a5 year period
revealed a 13.6% occurrence of side-effects in 40 patients. Most
of the reactions were minor with the majority being “dyspep-
sia” (27 cases). The most serious case was an episode of melena.
No deaths occurred and no evidence of hepatic, bone-marrow
or renal dysfunction.

Ibuprofen was administered for 12 months, at doses up to
1200mg to 30 patients with documented Peptic Ulcer Disease
(PUD) as demonstrated by endoscopy (6). In the 24 patients who
completed the whole study, no positive changes or new find-
ings were noted. Two patients dropped out for personal
reasons and 4 patients dropped out because of GI intolerance,
but no evidence of ulceration was found by X-ray or endoscopy.

Visual disturbances were reported when the drug first came
on the market (7). In a double blind prospective study, 78
patients with Degenerative Joint Disease (DJD) were studied
while on 1600mg. of ibuprofen for 24 weeks (8). Results from the
ophthalmologic examinations and historical findings did not
show eye toxicities.

A toxline as performed with assistance of Dr. Gary Oderda of
the Maryland Poison Information Center printed 24 articles with
their abstracts and revealed no significant adverse effects.

All of the references cited above plus the toxline do not reveal
significant adverse or toxic data which would preclude the use
of ibuprofen.

RECOMMENDATION

Ibuprofen appears to be an efficacious analgesic, antipyretic
and anti-inflammatory agent (in high dose) for Rheumatoid
Arthritis and Degenerative Joint Disease. Adverse reactions ap-
pear to be statistically and clinically less significant than aspirin,
indomethacin or phenylbutazone. This drug is not a replace-
ment for aspirin butis an acceptable alternative for patients who
can’t tolerate aspirin.

——

“Dr. Wiser is Assistant Professor, Division of Clinical Pharmacy, School
of Pharmacy/University of Maryland Hospital and Assistant Director for
Primary Care, School of Medicine, University of Maryland.

(Continued on Page 32)

THE MARYLAND PHARMACIST

Epidemiological Implications of Pharmacy Practice

by

Arlene Fonaroff Ph.D.*

Each of us on the social sciences panel have been asked to
identify and illustrate how his/her discipline applies to phar-
macy practice; to illustrate teaching methods and content; and
to discuss student receptivity to subject matter and perspective.
It’s fitting that the discussion on epidemiology appears as to-
day’s final paper because epidemiological thinking employs an
ecological approach in which there is a synthesis of variables
from social and behavioral sciences. Health and disease in the
community, after all, reflect what people think, feel and do as
they carry out activities of daily life through multiple roles in
multiple environments. Epidemiologists observe, measure and
analyze such environmental behavioral outcomes in relation to
health and disease in population or subpopulation groups in the
community.

Applicability of Epidemiology to Pharmacy. One’s probable
susceptibility to health and disease, disability, life expectancy
and death may be evaluated in relation to the epidemiology of
health and disease in the community or nation. The distribution
of health attributes in the population provide the foundation for
understanding community or national health status. While one
tends to view morbidity and mortality statistics and the inci-
dence or prevalence of disease’ with a dispassionate eye, each
Statistic reflects both the reality of a personal encounter and the
probability of a future encounter with disease, disability or
death. Such experiences also reflect the successes and failures
of multiple social and political and economic systems to pro-
vide citizens with opportunities which enhance the quality and
duration of life. Access and availability to pharmaceutical
products is part of this experience.

All communities contain multiple exposure and susceptibil-
ity to occurrence and sequelae of disease. Of significance in
epidemiological phenomena is the population’s concepts of
health and disease, since decisions stemming from these con-
cepts effect social values and goals, subsequent community
health action, and personal decisions for disease prevention
and health maintenance. Every human group throughout the
world has its unique concepts of health and disease, and as we
all know there are many differences, not only in disease con-
cepts held by laypeople and health professionals but within
each of these groups. Embodied in these concepts are defini-
tions of a healthy norm and a systematic way of identifying and
dealing with deviations. Note here that disease is considered as
a deviation from the norm while health is regarded as the
capacity to function in or adapt to environments. Whether in
rural or urban America, inner city neighborhoods or suburbia
(or remote African or Amazonian villages), the framework for
action or therapy occurs when deviations from this healthy
norm are defined.

This epidemiological perspective can provide both an intel-
lectual orientation and pragmatic materials for pharmacy. Let
us consider its orientation first and application second.

AUGUST, 1976

Orientation. Epidemiology is an ecological science which de-
scribes, measures and interprets the manner in which human-
environment interactions influence the occurrence and course
of health and disease in a population or subgroup within the
population. The focal point for obtaining data is the commu-
nity — also the practice setting for pharmacy. Epidemiology,
as human ecology, assumes that the individual, society and
culture, as well as the biotic and physicial environments exist
not as discrete components in isolation from each other, but as
a complex interacting network, or ecosystem, where each
component intimately affects the other. Through this interac-
tion, human groups are constantly striving to adapt to
everchanging environmental conditions. Successful human
adaptation indicates that the individual or group has reached a
state of health.

Epidemiology seeks to explain causal factors and the manner
in which their association influences the natural history of a
disease. In order for a disease process to become established,
the necessary ecological conditions must be present in the host
(people), the agent (physical, biological, chemical, social or
behavioral mechanisms) and the environment (physical,
biological, social), as well as the ability for each to sufficiently
interact with one another. For tuberculosis to occur, for exam-
ple, there must be a susceptible host (man), contact with a
viable tubercule bacillus and an adequate medium for ex-
change in which the agent may be transmitted. It has taken
many centuries for us to reach this level of understanding about
disease causality(1).

Over time, emphasis has shifted to different points in
epidemiological relationships and in definitions of how disease
causality occurs. Because the surge of epidemiological science
coincided with the need in the 19th century to investigate the
source, spread and control of major epidemics of infectious
diseases such as cholera, plague and smallpox, the traditional
emphasis was on infectious organisms as prime etiological
agents of disease. The epidemiological task was to identify the
specific agent that caused a specific disease in a specific popu-
lation; and the physical environment was considered the source

(Continued on Page 28)

*Dr. Fonaroff is Staff Officer/Research Associate in the Assembly of
Behavioral and Social Sciences, National Research Council of the
National Academy of Science. She also is an Associate Professorial
Lecturer in epidemiology and environmental health at George Wash-
ington University. When this paper was prepared, Dr. Fonaroff was

‘Assistant Professor of Pharmacy Administration, University of Mary-

land School of Pharmacy.
Reprinted with permission of the American Journal of Pharmaceutical
Education and the author.

25

:
Win a student loan fund for your

favorite college of pharmacy!

Time to participate in the $52,000
Burroughs Wellcome Co.
Pharmacy Education Program for 1976.

A $500 permanent
revolving student loan fund
for your favorite

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in your name

Every registered pharmacist in the United
States, including those in the District of Colum-
bia and Puerto Rico, is eligible.

Watch your mail for your

entry blank. it will arrive soon, along
with necessary instructions. Participating
couldn't be easier.

104 winners for 1976

Two pharmacists from each state, including
D.C. and Puerto Rico, will have individual
grants of $500 each, presented in their names
to the pharmacy colleges of their choice. The
grants establish permanent revolving student
loan funds to help deserving pharmacy stu-
dents complete their studies. BW. Co. is pleased
to contribute in this way to the continuation of
pharmacy’s high educational standards.

Burroughs Wellcome Co.
Research Triangle Park
North Carolina 27709

TK

Wellcome

“Thank you"

Drawings for winners to be
held at the N.A.R.D.

Convention

Convention dates: September 20-24, 1976
Location: San Francisco, California

You need not be present in order to win.

All winners will have their
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All entrants receive a
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e' Salute to Pharmacy’’
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¢Wellcome Trends in Pharmacy— Pry
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Fellowship and

The Wellcome Memorial Fellowship, granted for
field work in pharmacy

e Summer employment for undergraduate
pharmacy students at our production facilities
in Greenville, North Carolina

28

of specific disease agents (2). Eventually, the investigation for
the sole source of infection developed into a more comprehen-
sive approach for understanding the methods and causes of
disease transmission. We now understand that causality in-
volves not one but multiple causes stemming from complex
interactions between host, agent and environment. In addition,
we are now aware that certain diseases may manifest them-
selves in the host without the host experiencing the disease(3).
Not all persons experiencing causal factors actually experience
a disease, like the chronic cigarette smoker who does not de-
velop lung cancer or the person exposed to streptococcal infec-
tion who does not become infected.

Contemporary epidemiology recognizes the overwhelming
importance of social and behavioral mechanisms in the host as
‘‘agents’’ of disease. We also have altered our concept of what
constitutes ‘‘environment’’ to include not only tangible proper-
ties of the physical and biological world which facilitate host-
agent interaction, but properties of the social world as well.
Today, epidemiology emphasizes the overwhelming impor-
tance of social and behavioral mechanisms in the host which
operate as ‘‘agents’’ of disease(4). Such factors as, for exam-
ple, dietary habits, exercise and stress are ‘‘agents’’ in hyper-
tensive heart disease. Similarly, ‘‘environment’’ now also in-
cludes not only tangible properties of the physical and biologi-
cal world which facilitate host and agent interaction, but prop-
erties of the socio-cultural world as well. Population density,
overcrowded housing, pollution, poverty and family disor-
ganization may function as ‘‘agents’’ in many diseases.

With this expanded concept of disease causality, even what
constitutes a “‘disease’’ has changed. The public health and
community medicine concerns of today include: evidence of
lack of social well-being, failures of personal adjustment such
as alcoholism, drug addiction and mental illness, as well as
failures of community organization to provide adequate em-
ployment to vital human resource services such as health, edu-
cation, welfare, law, etc.(5). Today, the health of the commu-
nity is seen to be causally linked with the population’s biologi-
cal, social and cultural characteristics as they interact with
environmental and materials resources(6).

How better than to orient pharmacists to the dynamics of
health and disease than through epidemiology? The major goal
of epidemiologic investigation is to prevent and control disease
in human groups by identifying that part of the web of causa-
tion which is amenable to intervention. Drugs of course often
play a dominant role in intervention either for altering host
susceptibility or agent virility. Drugs may be used solely to
affect agent potency as in the case of an antibiotic. Drugs like
insulin, on the other hand, alter homeostatic mechanisms in the
host by enabling the body to appropriately metabolize sugars.

Disease processes, however, may be altered through en-
vironmental change, without touching either the person or dis-
ease agent, and without pharmaceutical technology. For exam-
ple, separating pedestrians (host) and cars (agent) into separate
traffic arteries (environment) decreases the probability of acci-
dental injury involving motor vehicles. Often, shifts in the
health status of the population may result from decisions that
do not consciously aim to eliminate pathogenic agents of dis-
ease. Elimination of poverty per se, for example, can drasti-
cally improve community health status through better housing,
Sanitation, and nutrition.

Implications of Pharmacy Practice. What does epidemiology
offer community and hospital practitioners who daily dispense
a multitude of drug products and information?

i
|

Among the actual and potential uses of epidemiology are: (i)
the definition of health problems for community action through
morbidity and mortality statements, their relative importance
and priority, and the identification of high-risk groups; (ii) the
analysis of operational health services to establish standards for
measuring efficacy of services, methods for improvement, and
directions for developmental community health programs(7),
Epidemiological methods are used in drug-use review to
evaluate the efficacy of physician prescribing habits and to
monitor adverse drug reactions, in clinical trails to evaluate
drug efficacy and interactions, and in community surveys to
identify perceived needs and uses of drugs.

In the past decade we have witnessed considerable move-
ment away from drug- or product-oriented practice to a current
emphasis on client-centered therapy where the person (who
may be a patient) with a problem (which might be a disease) is
in need of symptom relief or health maintenance, for which a
drug is to be administered. Let us remember that drugs, (dis-
pensing and consumption) after all, are indicators of disease
process within a practice environment and within the commu-
nity served by the pharmacy. A careful inventory of drugs for
which diagnosis may be objectively or subjectively correlated |
is indicative of the distribution of health problems which re-
flect communication and transaction between providers and
consumers of health care(8).

I contend that epidemiology provides an orientation for un-
derstanding the dynamics of health and disease in a community
which is overlooked by pharmacists in their customary one-
to-one relationship with a client. Epidemiology defines at the
macro-level the nature of health problems to which the
population-at-risk may be susceptible or may have already en-
countered. The community, or its population, after all, is a
composite of people who come to need and use pharmaceutical
services. A pharmacy in Harlem would house a different prod-
uct stock than one on the Navajo reservation. A pharmacy in
Sun City AZ would be unlike one on a college campus. At the
grass roots level, pharmacists are perhaps among the most able
of health practitioners to diagnose a community’s disease ex-
periences — at least those for which prescribed or nonpres-
cribed products are sought. They are in a central position to
refer individuals to community health resources, to refer the
particular or general community health trends to local public.
health and other human resource agencies, and to communicate
drug-related problems to private physicians.

The epidemiological approach, therefore, parallels the cur-
rent pharmaceutical approach for a patient- or client-centered
practice rather than a drug- or product-oriented practice. The
epidemological or ecological approach reminds us to consider
that multiple social and other environmental forces effect the
individual’s encounters with the drug-use process. As Kerr
White(4) recently wrote ‘‘At the very least, epidemiology
should help to sensitize medicine to society’s health needs and
prepare us for demand which will inevitably find expression
through the political process . . . a simple definition of our
discipline will suffice: ‘epidemiology is the study of that which
is upon the people.’ ”’

Teaching the Epidemiological Approach in Social Science.
The objectives generated for the University of Maryland
School of Pharmacy course in social sciences are based on the
philosophical position just described. On completing the
course, students are expected to demonstrate knowledge and
understanding in the following areas: (Continued on Page 30)

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(1) epidemiological factors influencing the drug-use pro-
cess, particularly the socio-cultural components in-
fluencing beliefs and behavior (specifically by defin-
ing and providing examples of how social, cultural
and behavioral factors influence the nature and dis-
tribution of community health status);

(ii) ecological factors influencing planning, organization,
delivery and utilization of health-care services (speci-
fically by defining how ecological factors interact to
influence health-care services);

(iii) the drug-use process as a system for maintaining
health and preventing illness (specifically by defining
components of the drug-use process and giving exam-
ples of how the process may be influenced by socio-
cultural determinants);

(iv) the client-centered health care approach (specifically

by defining the approach and illustrating its applica-

tion to pharmacy practice); and

potential opportunities for pharmaceutical services in

comprehensive health care (specifically by giving

examples of alternative ways in which pharmaceutical
services may increase personal and community health
care).

(v

~~

To acquire knowledge and understanding, the course utilizes
basic concepts for which substantive data is presented through
didactic lectures, films and class discussion. These concepts
include: (i) the health-disease continuum, (ii) health as adapta-
tion and drugs as adaptive mechanisms for health maintenance,
(iii) sociopharmacology (the manner and use of drugs in soci-
ety), (/v) the drug-use process (the system from perceived need
for a drug through to its utilization and feedback of continued
or future need), (v) human ecosystems (ecological interactions
between co-existent physical-social-cultural-psychological en-
vironments) that influence learned health behavior, (vi) the life
cycle or stages from conception through death, focusing on
health behavior as it influences susceptibility to illness experi-
ence and health maintenance, (vii) community diagnosis, a
method which links risk factors and behavioral factors for a
specific disease in a specific population (for example, risk and
behavioral factors in hypertension differ from those in diab-
etes), diagnostic indicators of personal and community health
(health status, morbidity, mortality, incidence, prevalence)
and drugs as diagnostic indicators of health problems, (viii)
socio-cultural variability in health/disease experience, (ix)
managing community health care (social values and social or-
ganization in health care delivery).

A required community project assignment provides students
with opportunity to observe and examine multiple environmen-
tal factors influencing personal and community health, and to
observe how these factors influence the drug-use process and
the delivery of pharmaceutical services. Students within a
10-12 person group either self-select or are randomly assigned
to a community facility or neighborhood. A paper is produced
by each group which defines personal and public cultural influ-
ences on a disease process characteristic in the community.
The case study method is used to demonstrate the course of the
same illness experience in persons of lower and upper class
backgrounds.

Student Receptivity. In my experience, pharmacy students
find basic social science content and approach incompatible
with the thought process required for mastering such subjects
as pharmacology, pharmacy, anatomy, physiology and

pathophysiology. While they are enthusiastic about client.
centered therapy, they have a false expectation of knowledg
required for its practice and grow impatient with what the
label ‘‘common sense’’ findings by sociologists and other ob-
servers of human interaction. They also have difficulty separat-
ing people from patients, health from disease, and incorporat-
ing a learning style divergent from the thrust of the basic sci-
ence curriculum. Many pharmacy students, like kindred stu-.
dents in medicine, nursing and other health professions, utilize
traditional mechanistic or reductionist models in learning
technological, medically-oriented problem-solving skills. Yet
clinical orientation (in the contemporary sense) requires a more
dynamic adaptive model of a sensing, understanding and reg-
ulating system governing the individual’s ability to cope with
external and internal stimuli(4).

A comprehensive health system (including education of its
providers) offers services for health promotion and mainte-
nance (the prevention of illness), care of the sick (treatment of
disease), and rehabilitation. Drugs and pharmaceutical services
play vital roles at each stage, since varying forms of
chemotherapy are the recommended procedures for altering
morbidity and mortality states primarily through altering host-
agent interaction. As we here all know, environmental and
other social control factors frequently prevent illness and pro-
mote the health of the population, reducing the monetary and
social costs of treating illness and rehabilitation of the disabled
in ways that drugs never can or should. While in addition to
death avoided, drugs may reduce the treatment period and
attendant costs of disease. Such reductions cannot be demon-
strated in all diseases and at all points in the health-disease
continuum and there are attendant social and economic costs
on the use of the drugs.

Epidemiology’s contribution to pharmacy education might
well be in providing the perspective for pharmacy students to
allow the shift from individual transactions between client-
practitioner to a broader collective concern for care of the
entire population. It is epidemiology, when ecologically
employed, that relates the individual to the population and that
has the potential to help balance personal and public needs,
burdens, risks and benefits(4).

Acknowledgement. Sincere thanks are extended to Dr. Benjamin
Hodes for comments made during preparation of this manuscript and
for the synopsis he delivered at the Seminar.

References

(1) Le Riche, W.H. and Milner, J., Epidemiology as Medical Ecol-
ogy, Churchill Livingstone, Edinburgh/London (1971) pp. 1-22.

(2) Susser, M., Causal Thinking in the Social Sciences, Oxford Uni-
versity Press Inc., New York NY (1973) pp. 16-17.

(3) MacMahon, B. and Pugh, T.F., Epidemiological Principles and
Methods, Little Brown & Company, Boston MA (1970) pp
48-51.

(4) White, K.L., Int. J. Epidemiology, 3, 295(1974).

(5) Rogers, E.S., Human Ecology and Health, Macmillan, New
York NY (1960) pp. 161.

(6) Kark, S.L., Epidemiology and Community Medicine,
Appleton-Century-Crofts Inc., New York NY (1974) ae

(7) Morris, J.N., Uses of Epidemiology, Livingstone, London/
Edinburgh (1957).

(8) Fonaroff, A. in Pharmacy, Drugs and Health Care, 2nd ed.,
(edit. Smith, M.C. and Knapp, D.A.), Williams & Wilkins, Bal-
timore MD (1975).

THE MARYLAND PHARMACIST

Big enough to
Service you....

Small enough to
know you

Today...as always

...IN quality,
experience, reliability,
Paramount means
personal service and
personal contact!

2920 Greenmount Avenue
Baltimore, Maryland 21218

Phone: Baltimore — 366-1155; Washington (local call) 484-4050

AUGUST, 1976 31

MeWs

New AACP President Calls for Identity,
Self-Study and Reform

Newly installed American Association of Colleges of Phar-
macy (AACP) President William J. Kinnard has called for the
pharmacy profession and its educational institutions to seri-
ously study contemporary practice roles and plan effectively for
the future. Citing the recent comments of Chief Justice Burger,
Dr. Kinnard noted the need to be jolted out of professional
lethargy and toward the nation’s future health care needs. He
was Critical of the patchwork approach to the roles and func-
tions of the pharmacist and argued for a more comprehensive
approach to professional development.

ey

While many of the new clinical pharmacy services are subject
to some controversy, the new President observed that “‘appro-
priate product selection, and adequate patient instruction must
become routine capabilities of our practitioners.” He cited the
need to work with other professions, the American Pharmaceu-
tical Association, and other Pharmacy groups in developing
roles and the appropriate practice competency standards. Dean
Kinnard noted the manner in which this could be facilitated
included support of the American Council on Pharmaceutical
Education in accrediting continuing education and by directing
the research resources of the colleges to practitioner problems,
such as the development and evaluation of modern reim-
bursement systems for pharmacy services.

The University of Maryland pharmacy Dean was highly critical
of the enrollment increases, undertaken at some colleges and
the proliferation of specialized educational programs when
some basic academic requirements are still not satisfied. He was
critical of the student/faculty ratios at some colleges and prom-
ised that the Association would direct a substantial effort to the
study of this problem. He also called for the elimination of
graduate programs at institutions which apparently lack the staff
and physical facilities required to offer quality graduate instruc-
tion. Dr. Kinnard believes that these limited resources could
best be spent by directing them toward the improvement of the
professional curriculum. He placed high priority on studying
this issue during his term as President.

The chief AACP officer called for an end to the old apprentice-
ship of post graduation practical experience. The President
stated that pharmacy was about the last holdout in this an-
tiquated approach to certification. He urged working with the
National Association of Boards of Pharmacy and the various
state boards to resolve the problem.

In commenting upon the Report of the Study Commission on
Pharmacy, Dr. Kinnard noted that the document was a guide
and nota mandate. He expressed concern over the definition of
and need for the ‘‘clinical scientists’ called for by the
Commission.

In the spirit of the Bicentennial, Dean Kinnard called upon the
delegates to “look past Remington and Proctor to 1776, (when)
we entered a very important time in the development of our

32

profession. Men such as John Morgan were working to spli
pharmacy away from its combined relationship with medicin
to achieve a singular identity for pharmacy. Let’s build on th
work of Morgan and others that followed, bringing our ow
pride and strength to advance the profession of pharmacy.”

LAMPA

In recognition of her many
years of service to the organiza.
tion, Ann Crane was select
LAMPA’s Honorary President. She.
has been Communications Secre.
| tary for fourteen years, during her
tenure working with seven
LAMPA presidents: Helen.
Kaminski, Ruth Levin, Sadye
Friedman, Lillian Slama, Mary.
Schrader, Dora Rockman and
Arlene Padussis. Using her
secretarial experience with a
major industrial corporation, she prepared excellent reports,
and communications, and authored the LAMPA NEWS column. |
Instinctively, she seemed to sense problems before they arose,
and capably solved them, whether it meant taking minutes,
making a prize, or doing whatever needed doing. She used her |
originality and creative ability to plan approximately 23 of LAM-
PA’s last 42 programs. In 1973, she compiled and edited LAM-|
PA’s Cook Book. Revising LAMPA’s By-Laws (a year-long pro-
cess) was another of her accomplishments. ‘‘Ann’s Tours” as.
she calls the nine trips she worked-up, are known for their.
well-planned, party-like quality. The trips ranged from a VIP.
tour of the White House in Washington, to the Mount Clare
Mansion in Carroll Park, in Baltimore.

She was asked to take the presidency of LAMPA several times,

but declined, saying she felt she could serve LAMPA better as |
secretary. |

She is a collector of fine china, is a prize-winning needle-
crafter, and enjoys cooking. Her outgoing, energetic personal-
ity has won her many friends in the pharmacy community.

In 1969, LAMPA surprised her with a luncheon in her honor.
She is LAMPA’s seventh Honorary President.

EE eee
Ibuprofen (Continued from Page 24)

REFERENCES
1. Blechman, W. J., Schmid, F. R., et al: Ibuprofen or Aspirin in Rheumatoid Arthritis Therapy,
J.A.M.A. 233(4): 336-339, 1975.

2. Hamatz, D., Rolstein, J., et al: Comparison of Ibuprofen and Placebo for Treatment of
Residual Symptoms in Gold-treated Rheumatoid Arthritis, J. Rheum, 1:4, 1974.

3. Royer, G. L., Moxley, T. E., et al: A Long Term Double Blind Clinical Trial of Ibuprofen and
Indomethacin in Rheumatoid Arthritis. J. Int’l. Med. Res. 3:3, 1975.

4. Royer, G. L., Moxley, T. E., et al: A Six Month Double-blind Trial of Ibuprofen and In-
domethacin in Osteoarthritis. Curr. Thera. Rsh. 17(2):234, 1975.

5. Thompson, M., Craft, A. W., et al: Ibuprofen in the Treatment of Rheumatic Disease: Long
Term Experience with Observations on Each of Adverse Effects. Curr. Med. Rsh. and Opin-
ion. 3(8):594, 1975.

6. Rijholic, V.: Long-term Ibuprofen Therapy of Rheumatic Disease in Patients with a Past
History of Peptic Ulceration. Curr. Med. Rsh. and Opinion 3(8):522, 1975.

7. Product Insert, UpJohn Mfg. Co.
8. Melluish, J. W., et al: Ibuprofen and Visual Function. Arch. Ophthal. 93:781-782, 1975.

THE MARYLAND PHARMACIST

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Membership —

Needs and Rewards
An Editorial

The Cost of Filling a Prescription

Dean E. Leavitt

Five Stages of Illness
Kenneth W. Kirk —

Drug Stability and Packaging
Ralph F. Shangraw

Who cares about
pnarmacists?

We do. Why? Because 362
of us at The Upjohn Company
are pharmacists. Including
the executives in this picture.

We understand the vital re-

lationship of pharmacist and
physician in the battle against
disease.

It's why we do all we can to
encourage professional de-

velopment...and to recognize
accomplishment in the field.

Care about pharmacists?
At Upjohn, we do.

°1975,The Upjohn Company, Kalamazoo, Michigan

Left to right: Reed B. Peterson, R.Ph.,
Vice President for Domestic Pharma-
ceutical Marketing; Louis C. Schroeter,
Ph.D., R.Ph., Vice President for Phar-
maceutical Manufacturing; and Anthony
J. Taraszka, Ph.D., R.Ph., Vice President
for Pharmaceutical Control.

The one the patient takes
is never tested.

Surprising, perhaps, butit makes sense
when you think about it.

Obviously, the actual dose of any pre-
scription drug the patient takes cannot be
tested because it would have to be broken
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never be used by a patient.

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THE MARYLAND PHARMACIST

650 WEST LOMBARD STREET
BALTIMORE MARYLAND 21201
TELEPHONE 301/727-0746

SEPTEMBER 1976 VOL. 52 NO. 9

CONTENTS

Editorial
6 Membership — Needs and Rewards
— Richard Schulz
Articles
8 Fact Sheet on Influenza and Swine Flu
— Public Health Service
12 The Cost of Filling a Prescription
— Dean E. Leavitt
15 Drug Stability and Packaging
— Ralph F. Shangraw
22 The Five Stages of Illness
— Kenneth W. Kirk
Departments
Calendar
18 Drug Evaluation — A Comparison of Ibuprofen, Fenoprofen,
Naproxen, and Tolmetin Against Existing Drug Therapies
— Michael D. Brown
28 Letters to the Editor/Open Forum
30 News
32 MPhA Travel Bulletin
ADVERTISERS
33 Abbott 7 Mayer & Steinberg, Inc.
11. Calvert Drug Company 32 Norcliff Thayer
17 CIBA 27 Paramount Photo Service
16 District Photo 31. Parke-Davis
13-14 Geigy Pharmaceuticals 20-21 Pharmaceutical Manufacturer's
9-10 Lederle Pharmaceuticals Association
3 Eli Lilly & Company, Inc. 25 Smith, Kline and French
4 Loewy Drug Company 2 The Upjohn Company
29 Maryland News 23 Youngs Drug Products

2
—$—$—$————————————————————:00OOO

Change of address may be made by sending old address (as it appears on your journal) and néw address
with zip code number. Allow four weeks for changeover. APhA members — please include APhA number.

The Maryland Pharmacist is published monthly, except for January, February, and March, 1976, combined,
by the Maryland Pharmaceutical Association, 650 West Lombard Street, Baltimore, Maryland 21201. Annual
Subscription — United States and foreign, $15 a year; single copies, $1.50. Members of the Maryland
Pharmaceutical Association receive The Maryland Pharmacist each month as part of their annual member-
ship dues. Entered as second class matter December 10, 1925, at the Post Office at Baltimore, Maryland,
under the Act of March 8, 1879.

SEPTEMBER, 1976

NATHAN I. GRUZ, Editor

RICHARD M. SCHULZ, Assistant Editor
Ross P. Campsett, News Correspondent
HERMAN BLOOM, Photographer

OFFICERS & BOARD OF TRUSTEES

1976-77

Honorary President

MORRIS LINDENBAUM

President

MELVIN N. RUBIN—Baltimore

Vice President

STANLEY J. YAFFE—Odenton
(replacing James W. Truitt, Jr.
who resigned)

Treasurer

ANTHONY G. PADUSSIS—Timonium

Executive Director

NATHAN |. GRUZ—Baltimore

TRUSTEES

HENRY G. SEIDMAN, Chairman
Baltimore

LEONARD J. DeMINO (1978)
Wheaton

S. BEN FRIEDMAN (1979)
Potomac

RONALD A. LUBMAN (1979)
Baltimore

ROBERT J. MARTIN (1977)
LaVale

ROBERT E. SNYDER (1978)
Baltimore

JERRY OVERBECK (1977)
Salisbury

(appointed to vacated position
of Stanley J. Yaffe)

EX-OFFICIO MEMBER
WILLIAM J. KINNARD, JR.—Baltimore

HOUSE OF DELEGATES
Speaker

VICTOR H. MORGENROTH, JR.—Ellicott
City

Vice Speaker

SAMUEL LICHTER—Randallstown
Secretary

NATHAN I. GRUZ—Baltimore

MARYLAND BOARD OF PHARMACY
Honorary President
FRANK BLOCK—Baltimore

President
|. EARL KERPELMAN—Salisbury

BERNARD B. LACHMAN—Pikesville
RALPH T. QUARLES, SR.—Baltimore
CHARLES H. TREGOE—Parkton
Secretary

ROBERT E. SNYDER—Baltimore

editorial

MEMBERSHIP — NEEDS AND REWARDS

Pharmacy has long been an area where the opportunities to
establish one’s professionalism have been subverted by many
external and internal forces. The recent Supreme Court ruling
which equates your professional contribution to that of a clerk
selling law books, is in one sense a slap in the face, but in
another sense, a much needed call to arms. Never has there
been such a need for unified, determined effort involving all
segments of pharmacy. The body of pharmacists who at this
time are hindered by factional interests must reassess their
position of individualism. It is only through a concerted effort
that pharmacy organizations can function as a viable agent
against those forces that challenge the essence and value of our
work.

An organization is only as good as the ideals which govern its
method and the wisdom to mold that method toward reaching
realistic goals. It is now within our grasp to accomplish much in
the areas of legislation, continuing education, news dissemina-
tion, social welfare, e.g. retirement plans, and public relations.
Whether or not we seize the opportunity and improve phar-
macy from what it is perceived to be today, is no longer a
unilateral decision. Although our motivations must be per-
sonal, our actions must be from a mandate. We must become
one voice respected by all with whom we come in contact.

Maryland Pharmaceutical Association can be that voice. As an
organization, our goals are to:

*® Represent the needs of the profession of pharmacy

® Actas a unified force in promoting those needs in the halls of
Annapolis and Washington

® Serve as the recognized forum through which problems sur-
face and are justly resolved

® Keep the pharmacists of Maryland abreast of current events
through the MPhA Newsletter

* Work toward establishing an equitable retirement plan for
our members

® Function as an educational tool by publishing informative and
Provocative articles in The Maryland Pharmacist and conduct-
ing seminars

Improve our image through an extensive public relations
campaign.

Before the Maryland Pharmaceutical Association can achieve
these goals, it must be the unequivocal voice of pharmacy in the
state. Our membership rolls must reflect the support and coop-
eration of pharmacists as one body. Any attempt at legislative
effectiveness must be founded on the axiom that in numbers
there is strength. Too many efforts in the past have been
undermined by a membership that did not exceed 50% of the
registered pharmacists in the state. We need you forustobea
more effective organization to insure that professionalism re-

mains a part of pharmacy. It is time for pharmacy to state its
declaration of interdependence; its members, its organiza- |
tions, its professionalism. Certainly none can survive alone.

This is a plea for membership; a drive that will culminate in
pharmacists becoming participants in determining their future, —
not just spectators. An aggressive stance must be assumed by |
all. It is now not enough to simply “donate” our monies. We
must actively seek the involvement of the many who have not _
committed themselves to the common good. It is not sufficient _
to be acquainted with our goals. They must be fully understood —
and spread widely to our non-member colleagues. The en- —
thusiasm we have with regard to the many positive aspects of
pharmacy must now be directed toward safeguarding our own |
existence,

Yes, this is a plea for new members. More importantly, how-
ever, it is a realization that the rewards of full membership are
for us to enjoy. The responsibility must likewise be equally
shouldered.

—Richard Schulz

calender

November 4 (Thursday) — MPhA Simon Solomon
Pharmacy Economics Seminar, Quality Inn,
Towson

November 17 (Wednesday) — Upper Bay
Pharmaceutical Association Meeting

November 18 (Thursday) — First Balassone Memorial
Lecture

November 18 (Thursday) — Baltimore Metropolitan
Pharmaceutical Association Annual Meeting

November 21 (Sunday) — Pharmacy Bicentennial
Dinner-Dance, Martin’s West, Baltimore
Beltway at Security Blvd.

1977

January 14-21 — MPhA Seminar and Tour —
Acapulco and Mexico City

March 5-13 — MPhA Trip to Vail, Colorado

April 14 (Thursday) — MPhA Spring Regional and
House of Delegates Meeting

May 15-19 — APhA Convention, New York City

THE MARYLAND PHARMACIST

- orenwnareccmneipiesceman onto ite cegprinee tase mie: cident amen mmnsnasen
$ * 2,

MPhA
DIVIDEND CHECKS!

As a participating member in the MPhA
Workmen’s Compensation Program,
you can receive a return of the profits

derived from your annual
premium. Every year! Up to 35%!
Interested? Ask Us!
This plan underwritten by A. D. |.

Your American Druggists’ Insurance Co. Representative

MAYER STEINBERG":

_ General Insurance Agents and Brokers

NEW ADDRESS
600 REISTERSTOWN RD. BALTO.. MD.

(301) 484-7000

Fact Sheet on Influenza and Swine Flu Virus

Department of Health, Education, and Welfare

Public Health Service
Center for Disease Control
Atlanta, Georgia

Q. What is influenza?

A.

Influenza is arespiratory disease caused by avirus. There are
two main types of influenza virus — A and B. Each type
includes various strains. Type A epidemics are generally
more frequent and severe. From time to time, new virus
strains develop. When this happens and if the strains are
quite different from previous ones, they may cause
epidemics because people have not had any previous expo-
sure to them and consequently have not built up any specific
immunity against them.

. How is influenza spread?

When aperson has influenza, or is just coming down with it,
the fluids in his nose and mouth contain viruses. They are
expelled into the air when he sneezes, coughs or talks. Then
they get into the noses and mouths of other people and
cause disease in the susceptibles.

. How serious a disease is influenza?

For most people, influenza is a moderately severe illness but
not a serious health threat. Complete recovery can be ex-
pected within a week. For certain high risk groups it is a
serious problem, and the disease or its complications may
be life threatening.

. What are the symptoms of influenza?

Symptoms of influenza often come on suddenly and may
include some or all of the following: fever, chills, headache,
dry cough, and soreness and aching in the back and the
limbs. Fever seldom lasts more than several days, although
the patient may continue to feel weakened for several days
to a week or more.

. What is the significance of the swine flu virus?

. The virus which causes influenza in man is constantly chang-

ing. Most of these changes are minor. Once every 10 years or
so the change is more dramatic, and this is when we have
extensive outbreaks such as the pandemic of Asian flu of
1957 and the Hong Kong flu of 1968. The newly identified
swine-like virus represents a major change from viruses
which are currently circulating in the human population.
Since it has the capacity to spread from person-to-person, it
could develop into a pandemic strain and cause extensive
illness and death.

Q. When was it first identified?
A.

In February 1976, a new strain of human influenza virus,
designated A/New Jersey/76 (Hsw1N1), was isolated during
an outbreak of respiratory disease among recruits in training
at Ft. Dix, N.J. Although an influenza virus of swine has been
known as the cause of the illness in swine for many years, the
Ft. Dix outbreak is the first known example in the United
States since about 1930 of person-to-person transmission of
a human influenza virus related to that of swine. The in-
fluenza virus of swine is relatively stable as opposed to the
changing virus which causes flu in people. (There is little
difference in the virus which caused flu in swine in the early
1930’s from that of today.)

. What relationship does this swine-like virus have to the 1918

influenza pandemic?

. Influenza viruses were first isolated from man in the early

1930’s. We can only speculate about the characteristics of
the viruses prevalent before that time. Testing of blood of
individuals who were living in 1918 shows almost all have
antibodies to swine-like virus. This suggests that a virus of
this sort may have caused the 1918 pandemic. Such an-
tibodies are also found in many persons over the age of 50,
suggesting that a swine-like virus was widespread in human
populations, perhaps up to 1930. There is, however, no
evidence to indicate that the virus recently identified at Ft.
Dix has the same characteristics of virulence as the 1918
virus.

- How was the 1918 influenza pandemic different from other

influenza pandemics?

. It was unique because of its high mortality, and the fact that

so many of the fatalities occurred among apparently healthy
young men and women. It is estimated that the 1918-19
pandemic resulted in a world-wide death toll of more than 20
million, with half a million of the fatalities in this country. By
comparison the Asian flu of 1957 — the most severe in-
fluenza pandemic since — caused an estimated 70,000
deaths, primarily among the elderly or individuals with
chronic illness.

THE MARYLAND PHARMACIST

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Presenting a broad line of Unit-Dose and Unit-of-Issue packaging,
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Q.

What has been found in the investigation of the extent of
human influenza caused by the swine-like virus?

It has been demonstrated that the initial outbreak of swine
influenza at Ft. Dix was fairly extensive. Although only 12
cases have been confirmed, extensive blood testing has
indicated that several hundred recruits were probably in-
fected during this outbreak. No spread to the nearby civilian
New Jersey population has been demonstrated. Hundreds
of blood samples of individuals from various sections of the
country have been tested. As expected, approximately 80%
of people over the age of 50 have swine-like virus antibodies
in their blood. Some individuals below the age of 50 also
have antibodies to swine virus. However, no additional in-
stances of person-to-person transmission within a commu-
nity have been demonstrated. In one family, blood tests
suggested that person-to-person spread had occurred
within that family, but notin the community. On the basis of
limited investigation thus far, it would appear that the in-
fluenza caused by the swine-like virus is no more virulent
than that caused by recently circulating strains of influenza.

. Is there a treatment for swine influenza?

. As with other strains of influenza, there is no specific treat-

ment. Science has, however, given us the ability to signifi-
cantly blunt the impact of this disease. Vaccines — not avail-
able in 1918 — are now an effective way to prevent the
disease. Antibiotics, also unavailable in 1918, are important
in treating the complications of influenza and thus reducing
fatalities.

Q.

A.

O:

A.

How effective would a vaccine be against influenza caused
by the swine-like virus?
Flu vaccines in the past have been variably effective, depend-

ing primarily on how closely they match the strain of in-
fluenza. Significant progress has been made in recent years.
Today’s vaccines are more potent, purer, and produce a
higher degree of protection with fewer reactions. It is gen-
erally believed that effectiveness ranges somewhere be-
tween 70-90%. When a distinctive new strain comes along,
scientists are generally able to better match a vaccine to the
new Strain, and itis likely that a high degree of effectiveness
could be achieved in a vaccine against the swine-like virus.
How would you go about immunizing more than 200 million

Americans?
The goal would be to immunize the population in a three-

month period — September through November 1976. The
nation has never attempted an immunization program of
such scope and intensity. It would require a major effort by
both the public and private sectors. Essentially, the plan
would rely on the Federal government for its purchasing
power, technical leadership, and coordination through the
Center for Disease Control; on State health agencies for
their experience in conducting systematic immunization
programs; and on the private health care sector for its exten-
sive medical and other health-related resources. The
strategy would be to tailor the approach to the opportunity
and need — using mass immunization techniques where
appropriate, but also using delivery points already in place,
such as physicians’ offices, health department clinics, and
community health centers.

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FOR DETAILS CONTACT TOM SOMERS
301-467-2780

THE CALVERT DRUG COMPANY

901 Curtain Avenue
Baltimore, Maryland 21218

SEPTEMBER, 1976

17

Damned If You Do, Damned If You Don’t

The Cost of Filling a Prescription

by Dean E. Leavitt, Ph.D.*

In May 1976 the Maryland Department of Health and Mental
Hygiene advertised through a ‘‘Notice to Potential Bidders” its
desire to engage a contractor to conduct a survey of pharmacy
operational data for the purpose of determining the actual costs
involved in the dispensing of prescriptions.

The survey was to include each of the approximately 800
community and outpatient hospital pharmacies located within
the State. A field audit of at least 40 pharmacies was to be
performed to verify submitted information. The contractor was
to supply the dispensing costs for each pharmacy, the average
dispensing cost for each type of pharmacy operation, and the
average state-wide dispensing cost. The task was to be com-
pleted in 90 days after award of the contract.

The Maryland Pharmaceutical Association has expressed jus-
tifiable concern regarding this survey and its results, so the
Association undertook its own cost survey. Using the method
recommended by the American College of Apothecaries, a
questionnaire was sent to all community pharmacies in the
State. Fifty-four usable forms were returned and analyzed.

The ACA method basically involves assigning costs to the
prescription department by:

(1) Estimating percentage of time spent in the department
by involved personnel
(2) Janitorial expense, rent, heat, light and power allocated
on a square footage basis
Prescription Department ft?
Whole Store ft? Sc
(3) Other expenses allocated on a percentage of sales basis

Prescription Department Sales
Whole Store Sales

Results
; Average eae!

Prescription Prescription Average
Volume Group (n) Volume _ Cost
Less than 10,000 2 7,500 $3.621
10,000—20,000 15 15,600 2.639
20,001-—30,000 le 24,941 2.804
30,001—40,000 10 34,900 2.141
40,001-50,000 5 42,600 AAO) |
50,001-60,000 3 54,333 2.287
An analysis of the data resulted in the following:

Average Cost: $2.535

Median Cost: 2.58
Weighted Average Cost 2.364
Range of Costs: 1.164.39

12

*Assistant Dean for Student Affairs, Professor of Pharmacy Administra-

24 GRAPH 1: FREQUENCY OF COST BY COST GROUP (N=54)

a

ERIE QU EN ¥

Cost 1.00-1.50 1.51-2.00 2.01-2.50 2.51-3.00 3.01-3.50 3.51-4.00 4.01-4.50
c

0S. 7

Graph 1, a frequency curve of cost by cost group, indicates
that the cost for 68.5% of the participants exceeded $2.00, while
only 31.5% reported costs of less than $2.00.

GRAPH 2: WEIGHTED COST BY PRESCRIPTION VOLUME GROUPS (N=54

2,60

COs7

cme ee eee eee ee

— ee — 52.00

WE {GOR 1 ESB.
&
°

16,000 24,000 32',000 405000
PRES CAR PPT 1 OK VOLUNE

Graph 2, the weighted cost by prescription volume group,
indicates that the cost of a prescription never drops below
$2.00, regardless of prescription volume.

(Continued on Page 31)

tion, University of Maryland School of Pharmacy.

THE MARYLAND PHARMACI

Tofranil-PM" Geigy
imipramine

In depression

Daily Dosage Chart

Tofranil-PM°

imipramine pamoate

One capsule
lasts from bedtime
to bedtime.

Initial Dose

Starting Usual Optimum
Dose Response Dose

oe

75 150
mg. mg.

For Maintenance Therapy

A Full Range to Choose From*

J UE E

150 Ws 100 TA)

mg. mg. mg. mg.

*Each capsule contains imipramine pamoate
equivalent to 150, 125, 100 or 75 mg. imipramine
hydrochloride.

Tofranil-PM®
brand of imipramine pamoate

Indications: For the relief of symptoms of depression.
Endogenous depression is more likely to be alleviated
than other depressive states

Contraindications: The concomitant use of monoamine

oxidase inhibiting compounds is contraindicated. Hyper-

pyretic crises or severe convulsive seizures may occur in
patients receiving such combinations. The potentiation of
adverse effects can be serious, or even fatal. When it is
desired to substitute Tofranil-PM, brand of imipramine
pamoate, in patients receiving a monoamine oxidase in-
hibitor, as long an interval should elapse as the clinical
situation will allow, with a minimum of 14 days. Initial
dosage should be low and increases should be gradual
and cautiously prescribed. The drug is contraindicated
during the acute recovery period after a myocardial infarc-
tion. Patients with a known hypersensitivity to this com-
pound should not be given the drug. The possibility of
cross-sensitivity to other dibenzazepine compounds
should be kept in mind.

Warnings: Usage in Pregnancy: Safe use of imipramine

during pregnancy and lactation has not been established:

therefore, in administering the drug to pregnant patients,
nursing mothers, or women of childbearing potential, the
potential benefits must be weighed against the possible
hazards. Animal reproduction studies have yielded incon-
clusive results. There have been clinical reports of con-
genital malformation associated with the use of this drug,
but a causal relationship has not been confirmed.

Extreme caution should be used when this drug is given

to

—Patients with cardiovascular disease because of the
possibility of conduction defects, arrhythmias, myocar-
dial infarction, strokes and tachycardia;

—Ppatients with increased intraocular pressure, history of
urinary retention, or history of narrow-angle glaucoma
because of the drug’s anticholinergic properties:

—hyperthyroid patients or those on thyroid medication
because of the possibility of cardiovascular toxicity;

—patients with a history of seizure disorder because this
drug has been shown to lower the seizure threshold:

—patients receiving guanethidine or similar agents since
Imipramine may block the pharmacologic effects of
these drugs

Since imipramine may impair the mental and/or physical

abilities required for the performance of potentially

hazardous tasks such as operating an automobile or
machinery, the patient should be cautioned accordingly

Usage in Children: Tofranil-PM, brand of imipramine

pamoate, should not be used in children of any age be-

cause of the increased potential for acute overdosage
due to the high unit potency (75 mg., 100 mg., 125 mg
and 150 mg.). Each capsule contains imipramine

pamoate equivalent to 75 mg., 100 mg., 125 mg. or 150

mg. imipramine hydrochloride.

Precautions: It should be kept in mind that the possibility

of suicide in seriously depressed patients is inherent in
the illness and may persist until significant remission oc-
curs. Such patients should be carefully supervised during
the early phase of treatment with Tofranil-PM, brand of
imipramine pamoate, and may require hospitalization.
Prescriptions should be written for the smallest amount
feasible.

Hypomanic or manic episodes may occur, particularly in
patients with cyclic disorders. Such reactions may neces-
sitate discontinuation of the drug. If needed, Tofranil-PM,
brand of imipramine pamoate, may be resumed in lower
dosage when these episodes are relieved. Administration
of a tranquilizer may be useful in controlling such
episodes.

Prior to elective surgery, imipramine should be discon-
tinued for as long as the clinical situation will allow.

An activation of the psychosis may occasionally be ob-
served in schizophrenic patients and may require reduc-
tion of dosage and the addition of a phenothiazine.

In occasional susceptible patients or in those receiving
anticholinergic drugs (including antiparkinsonism agents)
in addition, the atropine-like effects may become more
pronounced (e.g., paralytic ileus). Close supervision and
careful adjustment of dosage is required when this drug is
administered concomitantly with anticholinergic or sym-
pathomimetic drugs.

Avoid the use of preparations, such as decongestants
and local anesthetics, which contain any sympathomime-
tic amine (e.g., adrenalin, noradrenalin), since it has been
reported that tricyclic antidepressants can potentiate the
effects of catecholamines.

Patients should be warned that the concomitant use of
alcoholic beverages may be associated with exaggerated
effects.

Both elevation and lowering of blood sugar levels have
been reported.

Concurrent administration of imipramine with electroshock
therapy may increase the hazards: such treatment should
be limited to those patients for whom it is essential, since
there is limited clinical experience.

Adverse Reactions: Note: Although the listing which fol-
lows includes a few adverse reactions which have not
been reported with this specific drug, the pharmacological
similarities among the tricyclic antidepressant drugs re-
quire that each of the reactions be considered when imip-
ramine is administered.

Cardiovascular: Hypotension, hypertension, tachycardia,
palpitation, myocardial infarction, arrhythmias, heart block,
stroke, falls.

Psychiatric: Confusional states (especially in the elderly)
with hallucinations, disorientation, delusions; anxiety,
restlessness, agitation; insomnia and nightmares;
hypomania; exacerbation of psychosis.

Neurological: Numbness, tingling, paresthesias of ex-
tremities; incoordination, ataxia, tremors; peripheral
neuropathy; extrapyramidal symptoms; seizures, altera-
tions in EEG patterns; tinnitus.

Anticholinergic: Dry mouth, and, rarely, associated sub-
lingual adenitis; blurred vision, disturbances of accommo-
dation, mydriasis; constipation, paralytic ileus; urinary re-
tention, delayed micturition, dilation of the urinary tract.
Allergic: Skin rash, petechiae, urticaria, itching, photosen-

sitization (avoid excessive exposure to sunlight); edema
(general or of face and tongue); drug fever; cross-
sensitivity with desipramine.

Hematologic: Bone marrow depression including agran-
ulocytosis; eosinophilia; purpura; thrombocytopenia.
Leukocyte and differential counts should be performed in
any patient who develops fever and sore throat during
therapy; the drug should be discontinued if there is evi-
dence of pathological neutrophil depression.
Gastrointestinal: Nausea and vomiting, anorexia, epigas-
tric distress, diarrhea; peculiar taste, stomatitis, abdominal
cramps, black tongue.

Endocrine: Gynecomastia in the male; breast enlarge-
ment and galactorrhea in the female; increased or de-
creased libido, impotence; testicular swelling; elevation or
depression of blood sugar levels.

Other: Jaundice (simulating obstructive); altered liver
function; weight gain or loss; perspiration; flushing; uri-
nary frequency; drowsiness, dizziness, weakness and
fatigue; headache; parotid swelling; alopecia.

Withdrawal Symptoms: Though not indicative of addiction,
abrupt cessation of treatment after prolonged therapy
may produce nausea, headache and malaise.

Dosage and Administration: In adult outpatients,
therapy should be initiated on a once-a-day basis with 75
mg./day. This may be increased to 150 mg./day which is
the dose level which usually obtains optimum response. If
necessary, dosage may be increased to 200 mg./day.
Dosage should be modified as necessary by clinical re-
sponse and any evidence of intolerance. Daily dosage
may be given at bedtime, or in some patients in divided
daily doses.

Hospitalized patients should be started on a once-a-day
basis with 100-150 mg./day and may be increased to 200
mg./day. Dosage should be increased to 250-300 mg./day
if there is no response after two weeks.

Following remission, maintenance medication may be re-
quired for a longer period of time at the lowest dose that
will maintain remission. The usual adult maintenance
dosage is 75-150 mg./day on a once-a-day basis, prefer-
ably at bedtime.

In adolescent and geriatric patients, capsules of Tofranil-
PM, brand of imipramine pamoate, may be used when
total daily dosage is established at 75 mg. or higher. It is
generally unnecessary to exceed 100 mg./day in these
patients. This dosage may be given once a day at bed-
time or, if needed, in divided daily doses.

How Supplied: Tofranil-PM, brand of imipramine
pamoate: Capsules of 75, 100, 125 and 150 mg. (Each
capsule contains imipramine pamoate equivalent to 75,
100, 125 or 150 mg. of imipramine hydrochloride.)

(B) 98-146-840-A(9/75) 667120

For complete details, including dosage and adminis-
tration, please refer to the full prescribing informa-
tion.

GEIGY Pharmaceuticals
Division of CIBA-GEIGY Corporation
Ardsley, New York 10502

SA 11472

Drug Stability and Packaging

The Significance of Expiration Dating on Original
Containers and Repackaged Prescriptions

by Ralph F. Shangraw, Ph.D*

Last year the Maryland legislature passed a bill, later signed by
the Governor, which requires that a pharmacist affix to the label
of the container in which the medication is sold or dispensed
the expiration date of the medication if known, and appropriate
special handling instructions regarding proper storage. This law
has resulted in a great deal of confusion about the significance
of expiration dates when transferred from the manufacturers’
package to the dispensing container. The purpose of this paper
is to explore the scientific basis of expiration dates and to
present guidelines to the pharmacist for fulfilling legal respon-
sibilities.

There are many different definitions of an expiration date.
However, the U.S.P. XIX defines it as a date assigned for a
particular formulation and package of an article which identifies
the time during which the article may be expected to meet the
requirements of the Pharmacopeial monograph provided it is
kept under the prescribed storage conditions. The important
points of this definition are: a) Particular formulation, b) Particu-
lar package, c) Stored under prescribed storage conditions. By
this definition an expiration date is meaningless unless all three
of these conditions are controlled.

Although an expiration date is a finite date, it must be realized
that a drug product (an active ingredient in a finished form to be
administered to the patient) does not suddenly go “bad” on its
expiration date. Theoretically, any drug product begins to
deteriorate from the time it is manufactured. The rate of
deterioration varies from one product to another. For instance,
rates of degradation are known to proceed much more rapidly
in solution than in a solid state. Therefore, liquid dosage forms
are known to decompose more rapidly than capsules or tablets.
Some drugs, due to their inherent chemical properties (such as
biologicals and antibiotics), are much more unstable than
others.

The expiration date placed on the container is the date by
which the manufacturer can no longer be assured that the
product will meet the requirements specified in official com-
pendia. In most cases this is thought of in terms of potency, i.e.,
that the tablets, capsules, elixirs, etc. contain not less than 95%
nor more than 105%, or not less than 90% nor more than 100%,
etc. of labeled potency. However, the expiration date is also
applicable to other standards which might appear in a given

SEPTEMBER, 1976

monograph such as disintegration time, dissolution rate, con-
tent uniformity, etc.

Each manufacturer is responsible for carrying out experi-
ments to ascertain within what time period a product in a
specified container stored under prescribed storage conditions
will meet compendial standards. In most cases expiration dates
are assigned conservatively (a shorter time period than would
be predicted by experimentation) in order to assure that any
unit of that product in any stage of distribution will meet the
standards.

In addition to standards set by the U.S.P., the FDA has also
clearly stated a position on expiration dates as a part of Good
Manufacturing Regulations.

In the January 15, 1971 Federal Register, 21 CFR 133.14 was
amended to read:

122.14 Expiration dating.

To assure that drug products liable to deterioration meet
appropriate standards of identity, strength, quality and purity at
the time of use, the labels of all such drugs shall have suitable
expiration dates which relate to stability tests performed on the
product.

(a) Expiration dates appearing on the drug labeling shall be
justified by readily available data from stability studies such as
described in 133.13.

(b) When the drug is marketed in the dry state for use in
preparing a liquid product, the labeling shall bear expiration
information for the reconstituted product as well as an expira-
tion date for the dry product.

In the Preamble to the regulation, the FDA stated: “The
Commissioner of Food and Drugs concludes that the interests
of consumers must be served by the establishment of valid
expiration dates for all drug products. To allow time for the
orderly accumulation of data to support such dating, CFR 133.13
and 133.14 have been changed to set forth basic guidelines for
stability studies for all drugs, which studies will be used to
establish expiration dates. No drug container-closure system is
indefinitely stable and the manufacturer or packer of a drug
product is responsible for determining the stability characteris-
tic for each of his products (emphasis added).”

* Professor and Chairman of the Department of Pharmacy, University of

Maryland School of Pharmacy.

US

Itis clear from the above discussion that the expiration dates
placed on containers by a manufacturer are applicable only
when the product remains in the original container, and is
stored under prescribed conditions. Even in the case of recon-
stituted products the expiration date assumes that the reconsti-
tuted product is dispensed in the manufacturer’s container.

The question arises whether expiration dates can be trans-
ferred from one type of container to another. The evidence is
quite clear that they cannot. It is a well known fact that prescrip-
tion containers, particularly plastic vials used for repackaging
solid products, do not presently meet compendial standards for
“tight” or ‘well closed.” As a matter of fact, the U.S.P. has
recently extended to April 1, 1977 the requirement that prescrip-
tion containers meet the permeation standards for ‘tight’ and
“well closed” as determined by procedure specifiedin N. F. XIV
(page 888) and U.S.P. XIX (page 647).

Because manufacturers determine stability only in the con-
tainers in which they package their products and because pre-
scription containers used today do not meet specified standards
for moisture or oxygen permeability, the transferring of expira-
tion dates has no scientific basis.

The argument is often given that many drug products are
quite stable regardless of the container in which they are stored
and they would be stable in dispensing prescription containers
as well as the original containers in which they are packaged.
This is true for many drug products, but unfortunately there is
no easy means of identifying them. Therefore, indiscriminate
repackaging is risky.

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Another complicating factor of expiration dating is that it is
impossible to assure that labeled storage conditions will be!
followed once the container leaves the pharmacy. The most
common prescribed storage condition is controlled room tem
perature (15 to 30°C or 59 to 86°F). In addition, it is alway
advisable to store medication at low humidity levels as moisture
is the single most important factor in accelerating chemical
decomposition. As consumers often store drugs in medicine
chests in the bathroom where the highest temperature and
humidity conditions are known to exist, prescribed storage
conditions are often exceeded. This problem exists to a greater
degree when the drug is repackaged because the prescription
containers do not meet the standards of moisture permeability.

The Maryland law reads that the expiration date must be
transferred “if known.” It is clear that once the drug product has
been placed in another container the expiration date is no

On the basis of the above discussion the following recom-
mendations would seem to be valid guidelines for pharmacists |
to follow: |

1. For all products dispensed in original containers, the stated
expiration date should be retained on the label of the con-|
tainer as well as appropriate storage instructions. If the origi-
nal label is removed for some reason in the dispensing pro- |
cess, then the original expiration date and storage conditions |
should be transferred to the new label.

(Continued on Page 31) |

FOTO DATE: AUG., 1975

|
:

EISENHOWER USA

Post Card

Pat pending

POST-A- PHOTO peasonatizeo POSTCARD & GREETING CARD
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THE MARYLAND PHARMACIST

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DRUG EVALUATION

A Comparison of Ibuprofen, Fenoprofen,

Naproxen And Tolmetin

Against Existing Drug Therapies

by Michael D. Brown, R.Ph.*

Recently, four new drugs have been placed on the market for
the treatment of rheumatoid arthritis — ibuprofen, tolmetin,
fenoprofen and naproxen. What follows is an attempt to de-
scribe the disease process, the pharmacological treatments,
and the place which these new agents may occupy in the
therapy of the disease.

Rheumatoid Arthritis

This affliction occurs in one to three per cent of the popula-
tion, with women afflicted two to three times more often than
men. Onset usually begins between ages thirty to fifty. An
inflammatory process of unknown origin, it may be limited toa
single episode affecting a few small joints on both sides of the
body, lasting only a matter of weeks (10-20% of cases). Usually,
however, the condition is progressive, with intermittent acute
episodes, and of a degenerative nature which affects an increas-
ing number of joints, the bones which they connect, and the
vessels and nerves which serve them. Finally, distant organs are
affected — liver, lungs and heart.’

Treatment of the initial stages of the disease is limited to
analgesics and physical therapy, allowing the illness to run its
course. This attempts only to minimize the discomfort involved.

Chronic disease involves therapy aimed at manipulating the
host’s immune mechanisms. One group of researchers con-
tends that the problem lies in the host's inability to marshal
sufficient and appropriate immunological responses to deal
with the unknown cause. They therefore attempt to use drugs
which stimulate these responses (such as levamisole).

The majority of therapeutic measures involve attempts to
suppress the host immune systems, theorizing that until the
Cause of the disease and its cure are discovered, the best treat-
ment is to minimize damage caused to the host by its own
ineffectual immune system.?

It is this second school which employs the agents to be cur-
sorily discussed here. These new drugs have evolved in order to
circumvent the toxicities inherent with the older agents — aspi-

18

rin, indomethacin, phenylbutazone, even low-dose steroids.
The more drastic agents — gold, penicillamine, and the cyto-
toxics (those agents also employed in cancer chemotherapy) are
used only in fairly advanced disease, where their extraordinary
toxicities may be overshadowed by the desperate state of the
severely debilitated patient. These drugs will not be discussed
here.

Of the first four drugs mentioned, aspirin is generally con-
ceded as first choice therapy. Phenylbutazone and indometha-
cin offer insignificant advantage therapeutically, and are much
more dangerous. Steroids are more effective than aspirin, but
possess too many side effects to be considered as first-choice
therapy, including some affecting the disease process itself,
such as bone degeneration, as well as physical and psychologi-
cal properties of addiction. Any comparisons to be made with
the older drug agents will primarily be made with aspirin.

Characteristics of Aspirin
And the New Agents:
Advantages, Relative and Absolute,
Vis a Vis High Dose ASA
All four new agents offer these advantages over high-dose
aspirin:
1. Significant decrease in gastrointestinal disturbances
2. Significant decrease in auditory side effects — tinnitus,
hearing impairment
3. Novelty — as prescription drugs they may give the pa-
tient the feeling that the physician is doing more than
the patient can do for her/himself with an OTC (placebo
effect should not be dismissed lightly in a disease pro-
cess of an episodic and pain-predominated nature).

These advantages alone might be sufficient for better control
of the disease process, through better patient compliance.

“Staff Pharmacist, The Johns Hopkins Hospital.

THE MARYLAND PHARMACIST

Plasma Auditory
Peak Binding Disturb-
] Level Half-Life (% Gl ance
Drug (hours) (hours) albumen) Distress (%)
Ibuprofen ¢ 5 .75-1.5 2 90 10-20 3
| Tolmetin ° 7 * 3-1 0.8 99 10 5
i Fenoprofen ° '° 5—1 2.3-3 99 20 6-10
_ Naproxen" ? %) 11-20 99 10 8
Aspirin 2 4-30 50-70 20-41 40

i

(high-dose)

For the patient experiencing GI difficulties with aspirin, any of
the other agents might be employed, with the last choice prob-
ably being fenoprofen. Frank ulceration has been implicated in

_ naproxen therapy, and is possible with the others, so that close

}
i

monitoring with any is advised. If Gl upset occurs with any of

_ the new drugs, any other might be tried, since cross-tolerance

appears minimal."4

The rheumatoid patient is often titrated initially to a dose
which causes tinnitus, and is then minimally reduced.'® As a

- consequence, auditory complications are frequent, since anti-
_ inflammatory activity and hearing difficulty both occur at rela-

tively the same dosage range with aspirin, with plenty of inter-

_ patient overlap. If the patient complains of this, it can be seen
_ that either ibuprofen or tolmetin might be reasonable alterna-

tives.

Other Complications With The New Agents
Depressed patients would probably be better off without

tolmetin, which, because of its chemical relationship to in-

domethacin, has the highest incidence of psychological side

_effects.'®

Concommitant anticoagulant therapy is an indication for ini-
tial trial with ibuprofen, which on the basis of one study does

not seem to interfere with the actions of warfarin.'? The high

protein binding capacity of the other agents theoretically, at
least, should interfere with the sojourn of the anticoagulant in
the plasma, prolonging clotting time by displacing more active
drug into the system. Phenylbutazone shares this trait as well.'®
As for aspirin, its role in this condition has been discussed

elsewhere ad nauseum.

Fluid and sodium retention are important factors in the con-

| gestive heart patient. Tolmetin and phenylbutazone have been

mentioned as agents which might add to this difficulty, and may
require additional diuretic therapy as compensation.’

Withdrawal exacerbation of symptoms has been seen with
fenoprofen and can be anticipated with the other short-lived
agents, but probably not naproxen." As with steroids, tapered
withdrawal might be the answer.

Aspirin should not be used with the new agents, due to
mutual interference. If further analgesia is required, aceta-
minophen or a narcotic should be used."®

Head to Head: The New Agents

Although blood half-life may not correlate with effect on
inflamed tissue (see any good treatise on steroids), naproxen
and fenoprofen both are better at relieving the morning stiff-

SEPTEMBER, 1976

-

ness in R.A."* This advantage might be overcome by bedside
medication with the other two agents several hours before
arising (if the patient is capable of easily returning to sleep!).

One study gives the nod to the two drugs mentioned above as
far as efficacy, but due to significantly fewer side effects, actu-
ally favors naproxen."* But this study was of short duration and
did not include tolmetin. Therefore, let us await more definitive
long-range studies to say more than that all four agents offer
some advantages over present regimens in this area of
rheumatoid arthritis therapy.

One further caveat: side effects which show only after wide-
spread experience have yet to be demonstrated, so that the final
place for these agents is unassigned and will so remain, proba-
bly for years to come.

Additionally, although analgesic effect occurs fairly rapidly,
significant anti-inflammatory activity may not appear for several
months.

Acknowledgement to Natalie A. Brown, R.Ph. and Barry Means, R.Ph.,
M.S. for their assistance in preparing the manuscript.

References

1. Christian, C. A., “Rheumatoid Arthritis,” Beeson and McDermott,
eds., Textbook of Medicine, 14th Ed., pp. 142-7 (1975).

2. Decker, J. J., “Some Rheumatological Riddles,” / Rheum 3 (suppl.
2):1—7, 1975.

3. Griffith, R. H., ‘Corticosteroid therapy in rheumatoid arthritis,” D.
L. Azarnoff, ed., Steroid Therapy, pp. 78-83 (1975).

4. Davies, E. F. and G. S. Avery, “Ibuprofen: a review of its phar-
macological properties and therapeutic efficacy in rheumatoid dis-
orders,”” Drugs 2:416—44 (1971).

5. Dornan and Reynolds, ‘‘Comparison of ibuprofen and aspirin
treatment of rheumatoid arthritis,” CMA/ 110:1370-2 (1972).

6. Selly, M. S., et al., ‘Pharmacokinetic studies of tolmetin in man,”
Clin Pharm Ther 17(3):599-605 (1975).

7. Maibach, E., ‘European experiences in the treatment of rheumatic
diseases,”’ Curr Ther Res 19(3):350—63 (1976).

8. Tolectin, Package insert, McNeil Labs.

9. Rubin, A., et al., ‘Physiological disposition of fenoprofen in man
I,’’ J Pharm Sci 61(5):739-42 (1972).

10. Zuckner, J. and R. J. Auclair, ““Fenoprofen calcium therapy in
rheumatoid arthritis,” / Rheum 3(suppl. 2):18—22 (1976).

11. Segre, R. J., ‘Naproxen: metabolism in man,” J Clin Pharmacol
15(4):316-23 (1975).

12. Myhal, D., et al., “Naproxen: long-term study in rheumatoid arth-
ritis and ‘placebo pulse’,”’ ibid:327-33.

13. See Goodman and Gilman or any other basic pharmacology text.

14. Huskisson, E. C., et al., “Four new anti-inflammatory drugs: re-
sponses and variations,’’ BM/J(i):1048—9 (1976).

15. See The Manual of Modern Therapeutics or any review of arthritic
therapeutics.

16. Bain, L. S., et al., ‘Evaluation of anew preparation in the treatment
of rheumatoid arthritis,” Brit J Clin Pract 29(8):208—11 (1975).

17. Penner, J. A. and P. H. Albrecht, “Lack of interactions between
ibuprofen and warfarin,’’ Curr Ther Res 18(6):862—5 (1975).

18. Rubin, A., et al., “Physiological disposition of fenoprofen in man
I,” J Pharmacol Ther 12(3):449-57 (1972).

19. Rubin, A., et al., “Interaction of aspirin with non-steroidal anti-
flammatory drugs in man,” Arthr Rheum 16(5):635—45 (1973).

12,

National
Mesalth
Insurance

Thee Cesrasvsse Derusmisnstor

of Pealth Pros

RESEARCH

|

THERE AREA

LOT OF PEOPLE

Pharmacy today is in the spotlight, subjected to all
kinds of scrutiny. Your actions are being monitored and
judged, sometimes by unknown third parties.

The worry is that in the wake of this focus, your rela-

_ tionships with both doctors and patients will be weakened,

without offsetting benefits. Consider three examples:
Drug substitution Until recently, state pharmacy

laws, regulations, or professional custom have stipulated
that non-generic prescriptions be filled with the precise

products prescribed. But in the last five years, a number of
these laws or regulations have been changed, permitting
you, in varying degrees, to make the selection when a
multi-source product is ordered.

These changes have been taking place against a back-

ground of growing evidence that purportedly-equivalent

drug products may be inequivalent, since neither present

drug standards nor their enforcement are optimal. In fact,

the FDA has not enforced the same standards for hun-
dreds of “follow-on” products that it has applied to orig-
inal NDA approvals. This situation, it seems to us, is a
compelling reason for product selection to rest on a sensi-
ble interchange between doctors and pharmacists—and

not on legislative action.

The major advertised claim for substitution is reduced
prescription prices for consumers. Yet no documentation
of any significant overall savings has been produced, nor is
any likely, given the needs of pharmacy and the record

_of government in administering cost control programs.

MAC Maximum Allowable Cost, MAC for short, is

_afederal regulation intended to cut the government's
- drug bill by setting price ceilings for multi-source drugs
_ dispensed to Medicare and Medicaid patients. Unless the

prescriber certifies on the prescription that a particular
product is medically necessary, the government intends to
pay only for the cost of the lowest-priced, purportedly-
equivalent, generally-available product. The effect of the

GETTING BETWEEN
YOU AND YOUR
CUSTOMER.

program may be that elderly and indigent patients will be
restricted to products which someone in Washington be-
lieves are priced right, regardless of your economic or
professional judgments. Pharmacists will have little to say
about administration of the program, since government
will have absolute authority to make its prices and fees
stick. For other multi-source drugs on the MAC list, your
reimbursement would be limited to a product price ona
government “estimated acquisition cost” list and a state-
established professional fee.

The drug lag The future of drug and device research
depends upon a scientific and regulatory environment
that encourages therapeutic innovations. The American
pharmaceutical industry annually is spending more than
$1 billion of its own funds and evaluating more than
1,200 investigational compounds in clinical research.
Disease targets include cancer, atherosclerosis, viruses and
central nervous system disorders, among others. But there
is a major barrier to the flow of new drugs to patients: the
cost of the research is more than ten times what it was, per
product, in 1962, and whereas governmental clearance
of new drug applications took six months then, it com-
monly consumes two years or more now.

The FDA needs adequate time, of course, to consider
data. But it is equally clear that the present complex ap-
proval process contributes to needless delay of drug ther-
apy. That’s why the increased efficiency of the drug and
device approval process is vital to all our futures.

We suggest you make your voice heard on these issues
—among your colleagues and your representatives in state
legislatures and in the U.S. Congress.

It could make a difference to patients and to the prac-
tice of your profession tomorrow.

P-M-A

Pharmaceutical Manufacturers Association

1155 Fifteenth Street, N.W., Washington, D.C. 20005

The Five Stages of Illness and Their Effect
On Pharmacist-Client Communications

by Kenneth W. Kirk, Ph.D.*

There are two types of knowledge necessary to communicate
meaningfully with patients: (1) knowledge about the subject
matter being discussed, namely, the drug and the disease state;
and (2) knowledge about the person to whom the information is
being given. Emphasis typically is placed on the former type of
knowledge because it is the basis for formal pharmacy educa-
tion and state board licensure requirements. However, evi-
dence indicates that unless a pharmacist knows certain things
about his client, the effectiveness of his communicated drug
knowledge is diminished.

IIness Behavior

Medical sociologists study the social and behavioral aspects
of illness, part of which includes analyzing the various ways
people react to illness. Mechanic has stated, ‘Much medical
activity. . . requires an understanding of the cultural and social
pressures which influence an individual’s recognition that he
needs advice, his decision whether to seek it, his choice of
counsellor, his cooperation in carrying out any measures that
are suggested and his willingness to remain in contact should
there be any recommendation that further supervision is
needed.”

Certainly, pharmacists must take heed of Mechanic’s words
because patients do vary greatly in their responses to having
physicians prescribe drugs for them. This phenomenon is evi-
dent to a pharmacist every day of his practice. It can be a
frustrating experience to know you have information that would
help the patient, yet the patient, for some reason or other,
simply does not appear interested in receiving that information.
Much of this willingness or unwillingness to accept clinical
information is due to the fact that people pass through different
stages of illness when they suffer some type of medical malady.

A well-known medical sociologist named Suchman has di-
vided the sequence of medical events into five stages of illness
and medical care: (1) the symptom experience stage; (2) the
assumption of the sick role stage; (3) the medical care contact
stage; (4) the dependent-patient role stage; and (5) the recovery
or rehabilitation stage.? The purpose of this paper is to review
Suchman’s five stages of illness and demonstrate the important
role that pharmacists play when coming in contact with patients
in any one of the stages. Knowing how and why people change
their attitudes and behavior as they enter and leave particular
illness stages should make pharmacists more effective in coun-

selling patients about their drug therapy and other medical
needs.

Ko
No

Stage 1: The Symptom Experience Stage

Entry into the initial stage of illness occurs when the person
makes the decision that “something is wrong.” This subjective
feeling of discomfort leads to behavior that involves the phar-
macist more than in any other stage of illness. There are three
aspects of the symptom experience stage: (1) the physical expe-
rience, where the person feels pain or notices a rash or other
type of irritation; (2) the cognitive aspects, where the person
interprets the symptoms; and (3) the emotional response ac-
companying the physical experience and cognitive aspect of the
discomfort, which can range from nonchalance to fear or anxi-
ety.

Pharmacists need to continually remind themselves that
symptoms typically are not recognized and defined by the pub-
licin medically diagnostic categories, but rather in terms of how
the symptoms interfere with normal social functioning. For
example, a sinus infection is seldom interpreted by an indi-
vidual as a case of group-A Streptococcus pyogenes. Rather, it is
thought of as a ‘bug’ that’s keeping one from wanting to attend
the evening concert.

Itis also common for people to display a general resistance or
rejection of having to play the “sick role.’” The success with
which this ‘denial of illness’” occurs depends largely upon the
degree of pain or incapacitation produced by the symptoms.
This phenomenon helps explain why many chronic diseases
with their insidious, or gradually worsening symptoms go un-
treated for so long. Perhaps the best example of such symptoms
are the seven warning signals for cancer promoted continually
to the public by the American Cancer Society. One might first
think that people certainly would not need to be reminded of
the warning signals for cancer because the consequences can
be so severe. However, these seven symptoms, listed in Chart 1
below, do not cause considerable pain or incapacitation. As a
result, they easily go unnoticed or ignored by an individual,
oftentimes until treatment is too late.

(Continued on Page 24)

This article reprinted with permission from The Indiana Pharmacist and
the author.

“Associate Professor of Pharmacy Administration, School of Pharmacy
and Pharmacal Sciences, Purdue University.

THE MARYLAND PHARMACIST

Nowonder Trojans
are America’s number
one bestseller

EN

.. they're recommended by
more pharmacists than all other
brands put together.

(according to a 1976 survey by
a national drug magazine)

Trojans showed up as the No. 1 condom recommended by
pharmacists in the latest survey of a national drug magazine covering
one out of every ten drug stores from coast to coast.

And now both pharmacists and consumers have an additional reason to
remember and prefer Trojans. We've added a new premium
product to the Trojans line. Trojans Plus. They're the ultimate for
the intimate. They're tops in sensitivity...golden
colored, naturally shaped, and specially lubricated. And they have the
unforgettable name... TROJANS PLUS.

Youngs Drug Products Corporation (p

Piscataway, N.J. 08854

Change in bowel or bladder habits.
A sore that does not heal.

Unusual bleeding or discharge.

BR WwW NH =

Thickening or lump in breast or elsewhere.
. Indigestion, or difficulty in swallowing.

Obvious change in wart or mole.

N DD oO

Nagging cough or hoarseness.

Chart 1: Cancer’s Warning Signals!

Pharmacists should recognize this human tendency to reject
being sick and actively cooperate with promotional campaigns
of various health agencies and organizations in their com-
munities, such as the American Cancer Society. They should
provide information to their clientele and encourage them to
follow through with physician visits at the first sign of potentially
serious symptoms. Evidence shows the public needs these con-
tinual reminders.

Another aspect of the symptom experience stage is the rec-
ognition that people oftentimes are torn between two opposing
developments after they first discover symptoms: (1) they do
not want to bother the physician, or to have to wait in a physi-
cian’s office; but (2) they fear the consequences of waiting too
long to see the physician. As a result of this inner-conflict, the
individual often attempts self-treatment with over-the-counter
medications.

Thus, the pharmacist can serve as a bridge to help the person
decide whether or not the symptoms warrant seeing a physi-
cian. This, of course, assumes the pharmacist is involved with
OTC drug transactions in his pharmacy even if it involves merely
a brief encounter with the client when the sale is made by a
clerk. Preferably, the pharmacist would meet with the client
when the client first requests an OTC drug, but this is not always
possible when the pharmacist has other clients waiting for pre-
scriptions to be dispensed. The client, incidentally, likely will be
interested in any consultation with the pharmacist because he
probably has this inner-conflict which he has not been able to
settle himself.

One other important point to make is during this initial stage
of illness, the pharmacist probably is the only health profes-
sional with whom the individual comes into contact to discuss
the symptoms. Unavailability of a pharmacist typically results in
the person seeking the advice of a neighbor, working compan-
ion, family member, or advertisements appearing in magazines
and on radio and television. Too often, the pharmacist under-
sells his importance at this stage of illness which to many, seems
like a rather unimportant or insignificant stage for the pharma-

cist to be involving himself. Nothing could be farther from the
truth.

Stage 2: The Assumption of the Sick Role Stage

This second stage of illness is where the person makes the
decision that he is sick and needs professional care. The indi-
vidual seeks to validate his claim of being ill which, if accepted,
will excuse him from his normal social obligations and activities.
During this stage, the reaction of the person’s family and
employer become very important because without the moral

24

support of these other people, the individual probably will noi
follow through with plans to see a physician until the symptoms
become more severe.

An additional element of great importance during this illness
stage is whether OTC drugs, purchased during the symptom
experience stage, have brought about a change in the
symptoms. If an OTC drug has relieved or lessened the
symptoms, the person might delay advancing to the third stage
of illness. During this delay, the disease may reach more serious
proportions. Any pharmacist recognizes the potential conse.
quences of inappropriate OTC drug therapy. Since the only
purpose of OTC drugs is to relieve symptoms, rather than tc
cure disease, the biggest danger of such drugs is they can mask
symptoms that otherwise would alert the individual that he
should see a physician. A pharmacist noticing a client pur.
chasing an OTC antacid on a regular basis, for example, should
inquire into that person’s state of health. Many people ‘‘hide
ulcers” by ‘‘covering them up” with antacids which may tem:
porarily relieve symptoms, but do nothing to cure the ulcer,
Eventually, the antacid may have little or no effect in reducing
the physical discomfort at which time the ulcer probably will

have progressed to where the individual will require extensive
medical treatment.

Stage 3: The Medical Care Contact Stage

This third stage of illness is where the decision is made to seek
professional medical care. More explicitly, the individual is
seeking both a medical diagnosis and a prescribed course of
treatment. The initial medical diagnosis sets the stage |
subsequent medical care. The person might refuse to accept the |
diagnosis and search for another source of medical advice,
possibly someone whose diagnosis will “agree’’ with the self- |
diagnosis made by the individual. |

A pharmacist should be careful about agreeing with a client
who is describing and diagnosing his own symptoms because
such a person may be seeking assurance that he is right and the
physician whom he has just seen is wrong. It is easy for a_
pharmacist to ignore these people, particularly when prescrip- _
tions are waiting to be dispensed and the person is talking to the —
pharmacist while the pharmacist is attempting to prepare a_
prescription for another client. Oftentimes, the easiest re-
sponse to such a person is simply to agree with whatever is
being said in hopes that the person will be on his way and let the |
pharmacist concentrate on his prescription dispensing. How- -
ever, a pharmacist should do his best to prevent this from |
happening because he may become an unwilling accomplice in
encouraging the person to ignore what his physician has diag-
nosed and to rely instead on his self-diagnosis which has been
“confirmed” by the knowledgeable, community pharmacist.

It should now be evident that when a person seeks consulta-
tion with a pharmacist regarding OTC drug therapy, it is vitally
important for the pharmacist to first determine in what stage of
illness the person is. Questions which the pharmacist should
attempt to have the individual answer include the following: (a)
Has the individual just discovered his symptom? (b) Is the per-
son dissatisfied with his physician’s diagnosis? and (c) Is the
person discouraged from having followed the physician’s or-

THE MARYLAND PHARMACIST

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DEAN SULLIVAN

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BILL HYSSONG GORDON KNIGHT
em oe JOHN O'MALLEY
MIKE GERSHEN

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WERE PUTTING
OUR BEST FACES FORWARD

The faces of SAGF Representatives who stand ready

to help you in any way with anything to do with SKGF.

If you have @ question or a problem, just ask. +
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Smith Kline & French Laboratories i)

Division of SmithKline Corporetion

ders for some time seemingly with no results? A pharmacist’s
approach with a client will differ depending upon the stage of
illness through which the client is passing. Proper advice for a
person in the first stage of illness may be inappropriate and
possibly harmful for another person in the third stage of illness.

Stage 4: The Dependent-Patient Role Stage

This fourth stage of illness is where the decision is made to
transfer control to the physician and to accept and follow the
physician’s prescribed treatment. Technically, it is not until this
stage that the person becomes a patient. The acceptance of
patient status is not easy for most people in our society.

People tend to avoid this dependent-patient role, but they
accept it when they see it as the only possible way they can
return to their normal social activities.

An important difference between hospital and community
pharmacy practice might be made at this point. Studying hos-
pitalized patients represents a “‘biased’’ sample of the popu-
lation because these people have proceeded through three of
the five illness stages. It is somewhat easier to predict how these
people will behave, particularly because drug therapy and other
medical treatments are administered to them by hospital per-
sonnel. In community practice, on the other hand, a pharmacist
is exposed to people in each of the five stages and it is important
for the pharmacist to be able to determine the appropriate
approach for a person in a particular stage.

It also is in this dependent-patient role stage where many
social and psychological barriers can interfere with the proper
course of treatment. Any breakdown in the physician-patient
relationship can result in the patient digressing to one of the
previous stages of illness. Dissatisfaction with a physician’s
treatment results could lead a patient to seek the counsel of less
qualified medical practitioners or even to see medical
“quacks.” Evidence of this phenomenon is seen in the millions
of dollars spent annually by those unfortunate people who
purchase the myriad of “cancer cures” available from disreput-
able people whose sole purpose is profit-making at the expense
of seriously ill patients.

Pharmacists must, therefore, accept the responsibility of
helping patients follow a physician’s prescribed treatment.
Noncompliance is being recognized today as a serious problem
and one which pharmacists can readily detect through the
proper use of patient drug profiles.’ A change in the time period
between refills on maintenance medications or a sudden
change of prescribing physicians should alert the pharmacist to
the possibility that a conflict exists between the patient and the
physician. The pharmacist should attempt to determine if sucha
conflict does exist and if so, take immediate and appropriate
action to see that the patient continues on the proper course of
therapy. It is easy for chronically ill patients to become dis-
couraged periodically, and the pharmacist can play an impor-
tant role in assuring such people that their therapy is helping
them and that failure to follow the prescribed treatment could
lead to a drastic change in their health status.

26

Stage 5: The Recovery or Rehabilitation Stage

During this stage the patient makes the decision to relinquish:
the patient role and either resumes his role as a healthy indi-
vidual or adopts a new role of chronic invalid or long-term:
patient needing rehabilitation. With the increasing incidence of
chronic diseases, public health concerns of these patients need
more attention by all health practitioners. Among these public.
health concerns are home care for the aged, rehabilitation for!
the handicapped, and long-term care for the chronically ill.

Pharmacists have numerous opportunities awaiting them
through their involvement in providing pharmacy services to.
nursing home residents. A recent article by Brown in another,
journal explored the federal regulations that now exist for
pharmacists serving in skilled nursing facilities.* These regula-
tions give pharmacists responsibilities far beyond the mere”
dispensing of prescription drugs. Pharmacists have a needed
role to play in assuring that quality pharmacy services are pro-
vided to this often neglected segment of our society.

Pharmacists also come into contact with patients who have’
just learned they will be taking some type of prescription drug |
therapy for the rest of their lives. This experience can be difficult
for a patient to accept, and the pharmacist can do much to
alleviate the initial fear and anxiety that occurs when a patient
learns he has a chronic ailment requiring maintenance drug
therapy of some type. The initial acceptance of sucha condition
could well determine whether the patient will comply with the
prescribed treatment, or retreat into other stages of illness in
search of another diagnosis or another “solution” to the prob-
lem.

Summary

The pharmacist probably is the only health professional who
comes into contact with people in each of the five stages of
illness. This puts him in the important position of being able to
help and counsel people with all types of medical needs. How-
ever, a failure to recognize clients in particular stages of illness
can result in the “right advice being given at the wrong time.” A
pharmacist must take the initiative in obtaining specific infor-
mation from a client, whether that client has a prescription or is
searching the shelves for an OTC drug product. Each client
should be viewed as a unique individual with unique needs
which can only be identified by communicating one’s interest
and concern for that individual. Knowledge of the five stages of
illness will help the pharmacist communicate more effectively
and meaningfully with his clientele.

)
1

References

1. Mechanic, David, “Response Factors in Illness: The Study of Illness
Behavior,”’ Chapter Nine in Patients, Physicians and Illness by E. Gartley
Jaco, The Free Press, New York, 1972, p. 128.

2. Suchman, Edward A., “Stages of Illness and Medical Care,’ Chapter
Eleven in Patients, Physicians and Illness by E. Gartly Jaco, The Free
Press, New York, 1972, pp. 155-157.

3. For an informative article on patient noncompliance, see Hussar,
Daniel A., “Patient Noncompliance,” J. APhA NS15:183-190, 201 (April
1975)

4. Brown, Charles H., “Clinical Pharmacy Services in Skilled Nursing
Facilities,” Indiana Pharmacist 56:51-54, 60-61 (March 1975)

THE MARYLAND PHARMACIST |

Big enough to
service you....

Small enough to
know you

Today...as always
...IN quality,
experience, reliability,

Paramount means

personal service and

personal contact!

2920 Greenmount Avenue
Baltimore, Maryland 21218

Phone: Baltimore — 366-1155; Washington (local call) 484-4050

Letters to the Editor

Dear Sir:

| read with interest Ms. Love’s article concerning skin tests for
anergy in the Jan./Feb./Mar. issue of The Maryland Pharmacist.
However, | feel that a significant error has been made regarding
the stability of Streptokinase-Streptodornase test solutions. Ms.
Love states that, ‘‘the test solution is stable after reconstitution
for 12 months if refrigerated.’’ Personal correspondence with
the manufacturer (enclosure) indicates that stability can only be
guaranteed for one week following reconstitution and refriger-
ation. This may have grave therapeutic implications since the
validity of the test may be suspect if outdated test solutions are
used. | suggest that a correction is indicated.

Sincerely,
Robert J. Michocki, M.S.
Assistant Professor,
Clinical Pharmacy
Division of Clinical Pharmacy
University of Maryland,
School of Pharmacy

Editor's note: The following letter was sent to the Division of Clinical

Pharmacy, University of Maryland School of Pharmacy from Lederle
Laboratories.

Refrigeration is definitely required for VARIDASE® Intramus-
cular Streptokinase-Streptodornase before it is reconstituted
for use and it should be kept in a refrigerator after reconstitu-
tion when not in use at 36°-50°F. It will then remain stable for
one week. At room temperatures, preparations will not remain
stable for more than 24 hours.

We do not have an official indication for use of VARIDASE as a
skin test. Reports in the literature indicate that VARIDASE has
been used for this purpose. | am listing below references for
several published articles in which the authors report this use of
VARIDASE. VARIDASE could not be marketed in a form suitable
for skin testing without elaborate clinical trials to establish its
reliability for this indication.

According to the reports in the literature, VARIDASE Intra-
muscular was used diluted to contain 50 to 100 SK units per ml.
0.1 ml. was administered intradermally.

VARIDASE was used with a series of other skin tests, namely
antigens to which the probability of patient sensitization is high
(e.g., Mumps vaccine, tuberculin, histoplasmin, candidin,
trichophytin, etc.). It is not likely that a patient with unimpaired
cellular immune competence would not develop a delayed skin
reaction to at least one of these antigens, and more than 99% of

normal individuals will give a reaction to at least one of the
antigens.

Very truly yours,
Stephen A. Szumski, Ph.D.
Medical Advisory Department
References
1. Hersh, E. M., Whitecar, J. P., McCredit, K. B., Bodey, G. P., and

Freiereich, E. J.: Chemotherapy, Immunocompetence, Immuno-

suppression and Prognosis in Acute Leukemia. New. Eng. J. Med.
285(22):1211-1216 (Nov.) 1971.

2. Chilgren, R. A., Meuwissen, H. J., Quie, P. G., and Hong,
Chronic Mucocutaneous Candidiasis, Deficiency of Delayed Hy
sensitivity, and Selective Local Antibody Defect. The Lancet,
688-693 (Sept. 30) 1967.

3. Lazarus, G. S., Goldsmith, L. A., Rocklin, R. E., Pinals, R. S., Bu
seret, J., David, J. R., and Draper, W.: Pyoderma Gangrenosu
Altered Delayed Hypersensitivity and Polyarthritis. Arch. De
105(1):46-51 (Jan.) 1972.

4. Taylor, F. B., Green, G. R., and Tomar, R. H.: Separation of a Materi
in Streptokinase-Streptodornase which Induces Delayed Skin Rea
tion. J. Allergy and Clin. Immuno. 48(1):23-27 (July) 1971.

5. Mitchell, R. J.: The Delayed Hypersensitivity Response in Prim

Breast Carcinoma as an Index of Host Resistance. Brit. J. Su
59(7):505-508 (July) 1972.

Open Forum

|, like the majority of pharmacists and pharmacy owners, wa}
apathetic for the past several years. Disgusted with what hac
happened and what was happening, | went my own way. |
refused to pay my dues to the associations and participate ir|
their activities. | refused to be active for two reasons: first,
asked myself what value could one person be; second, | kne\
my ideas and suggestions would meet much opposition. Lik
the rest of you, | went my own way, complaining to myself an
friends, until | was struck by a bolt of lightning called MAC.

Se

It became inevitable that | had to become involved and figh
in order to preserve my future livelihood. | paid my dues, made
contributions, and worked with the Association. | was elated ’
learn that the officers in the Association welcomed my help an
had open minds. I joined others who felt as | had in the past, an d
by working with them and the Association found the nucleus of

a strong and dedicated, determined team.

The new group together with the Association achieved suc-
cess heretofore unheard of in pharmacy. | must state however
that these gains are not permanent and much remains to be
done in order to insure our future. One outstanding fact has
been proven. It can be summed up in that old adage, “In uni
there is strength’. If any of you still think you can sit on the
sidelines and ignore the problems we are confronted with, you

will have only yourselves to blame when you close the doors to
your pharmacies for the last time.

Our survival is dependent upon each and every member
becoming involved personally and fighting for what is justly
ours both as individuals and as a profession. If you want to be
honest with yourself take the time today to determine your
actual cost of filling a prescription. You will be shocked to learn

that you have been providing a professional service at your own
expense.

If in the future it becomes necessary for pharmacies to close.
because they could not provide needed health services at their
own expense, just look around and see who did not become

involved in this fight for survival. There will be no doubt upon
whom the blame should fall.

Donald Schumer, R.P
Baltimore, Maryland

THE MARYLAND PHARMACIS

1
'

A lot of fine products
compete for the custom-
ers dollars, at your phar-

macy. So, when it comes time
to stock your shelves, TH

MARYLAND NEWS DISTRIBUTING ) = Ti

COMPANY is well aware of your needs. iM

Our product is periodicals — magazines
and paperback books — and we continually
supply your racks with a variety of current
reading material appealing to every taste and
keeping your customer reader interest at its
highest.

We understand that turnover is important.
With periodicals you have a sufficient new
product each month to stimulate traffic not
only for our product, but for a// the products
in your store.

An investment of $100 in periodicals,
normally will result in $127 of sales within 30

days. Not bad! Then
W think of all the other
/ products you will sell.
WI Further, since all unsold
Sev@ copies of our product are return-
able for credit, there is absolutely
no risk.
But perhaps the most important fact
is that periodicals have an unselfish way of
helping to sell every other product in your
store. Take a look at the pages of our maga-
zines and see how they showcase just about
every other product that you sell over and
over again. It is like having a built-in
salesman.
To learn how you can really “help your-
shelf,’’ why not give us a Call;
The Maryland News Distributing Co.
(301) 233-4545
Ask about periodicals, the unselfish product.

Se

MeWs

Baltimore Metropolitan
Pharmaceutical Association

The Baltimore Alliance Against Venereal Disease expressed its
appreciation to the Baltimore Metropolitan Pharmaceutical
Association for its financial contribution and to Richard Schulz
who represented BMPA at the Alliance’s booth at the Baltimore
City Fair. Mr. Schulz devised a veneral disease self-test which
was distributed to those who visited the booth.

Future work between these two groups will maximize the

pharamcists’ input in the area of venereal disease information
and education.

Burroughs Wellcome Announces

Local Winner

Richard E. Greenberg, R.Ph., of Baltimore is one of 104
national winners in the ‘‘Win A Student Loan” contest
sponsored by Burroughs Wellcome. The $500.00 award was
presented to Dr. William J. Kinnard, Ph.D., Dean of the School
of Pharmacy, and is to be used as a revolving loan fund for
deserving students in the name of Mr. Greenberg.

From left to right: Ray Smith, local representative;
Alex Cradle, District Sales Manager; and Richard E.
Greenberg of Vilma Pharmacy.

30

Noxell Appoints |
Group Product Manager

Noxell Corporation of Baltimore, Maryland, has announce
the promotion of Philip C. Crosland to the position of Grou
Product Manager for the Toiletry/Household Products Marke
ing Division. In his new post he will be responsible for the ney
Raintree line and Lestoil.

Mr. Crosland, formerly New Products Manager in the Co:
metic Products Marketing Division, joined Noxell in 1974. Hi
previous affiliations were with Ted Bates Advertising and SSC&
Advertising, both in New York City.

Mr. Crosland holds a B.B.A. in Marketing from the Universit
of Wisconsin.

James E. Allen, Jr. Elected
Executive Vice President Of Gilpin

The election of James E. Allen, Jr. to the office of Executive
Vice President has been announced by The Henry B. Gilpin
Company, a major distributor of drugs and health care prod-
ucts, headquartered in Washington, D. C. Mr. Allen is respon-
sible for the direction of all corporate and subsidiary
operations.

Prior to joining Gilpin in 1974 as Vice President of Planning
and Development, Mr. Allen established a broad base of expe-
rience in industrial and business management, as well as sales
and marketing management, with the firms of Procter &
Gamble, IBM, and Memorex. Mr. Allen is a graduate of the
Massachusetts Institute of Technology.

The Henry B. Gilpin Company, which was founded in 1845,
and its subsidiary companies operate six wholesale drug dis-
tribution centers and surgical supply, service merchandising,
and drugstore franchising businesses located throughout 13
eastern, midwestern, and southern states, and the District of
Columbia.

School of Pharmacy

Dr. Larry L. Augsburger of the University of Maryland School
of Pharmacy has been awarded a $46,440 14-month contract
from the Food and Drug Administration (FDA) to develop a
laboratory dissolution method/specification that meets the reg-
ulatory need for assuring uniformity of bioavailability (clinical
effectiveness) from lot to lot and from different manufacturers
of the thiazide diuretics.

Drugs with poor solubility (such as the thiazides) are not
always released from dosage forms in an efficient manner.
Various factors including the physicochemical properties of the
drug itself and how the dosage form is formulated and pro-
cessed can significantly affect the dissolution of the drug from
its dosage form.

THE MARYLAND PHARMACIST

rug Stability (Continued from Page 16)

_ In those cases where the drug product is repackaged, the
original expiration date should be considered invalid. The
pharmacist may, if he wishes, place an arbitrary expiration
date on the label (not to exceed one year) in order to prevent
use after long periods of time in uncontrolled circumstances.

}. The pharmacist should recommend the same storage condi-
tions for repackaged drug products as were required on the
original container. This should in most cases be optimal for
the product under most repackaging conditions.

A number of forces are presently in motion which will result
n little or no repackaging by the pharmacist. In addition, tighter
standards for dispensing containers will be in effect April 1,
1977. In the meantime, the above recommendations would
appear to conform with the spirit of the law within the limita-
tions of being both practical and scientifically sound.

Prescription Cost (Continued from Page 12)

Table 1 — Type of Practice of Participants (n=54)

ee a ae
Professional Pharmacy (6) 24.1
Traditional Pharmacy 37 68.5

__Super Self-Service Pharmacy ___ nd Ee

Analyzing only the professional shop and the super self-
service (the traditional type of practice would have statistics
very close to those reported for the whole group) the weighted
average costs are:

Average Weighted
Prescription Average
——— a MOS oS
Super Self-Service 28,500 $2.55
Professional Shop P25 3.076

Discussion

Very little should be inferred from a sample of 54 out of a
population of 800, especially if today’s research will become
tomorrow’s State dispensing fee.

The cost of filling a prescription is a highly emotional political
question which won't be solved by objective research. The
pharmacist can’t win and may, in the process, cut his own
throat! So, no matter who collects the data, Lasser or Leavitt, the
results will produce only more numbers and each can guess
their correlation with actual cost.

As long as government insists on analyzing prescription
prices, a subsection at a time, MAC, EAC, dispensing cost, etc.
and never gets down to ensuring some level of net profit along
with the other elements, there is very little hope of coming up
with actual dispensing costs.

SEPTEMBER, 1976

BNO

ee
THE AMERICAN PHARMACIST
om KKK KKK KKK KKK
A HERITAGE OF RESPONSIBILITY

THE GOVERNOR
WHO HEALED THE SICK

MANY EUROPEANS “of quality and wealth,
particularly those who were nonconformists in
religion” were attracted to the possibilities of the
American Colonies. From Britain came
John Winthrop, first Governor of Massachusetts
Bay Colony and founder of Boston. Governor
Winthrop, unable to induce professionals to the
Colony, sought advice from English apothecaries
and physicians, and added to his small store of im-
ported drugs those derived from plants native to
New England. In his home (about 1640), he made
available as best he could the “art and mystery”
of the apothecary for his citizens.

presented as a service of

PARKE-DAVIS
A HERITAGE OF RESPONSIBILITY

@1953 Parke, Davis & Company,
Detroit, Michigan 48232

PD-JA-2012-1A-P(9-76)

31

MPhA TRAVEL BULLETIN |

SKI VAIL, COLORADO

March 5-13, 1977

$359.00 per person per double occupancy

Special Rates for Children under 12

Trip includes round trip via United Airlines Charter
8 days and 7 nights at the HOLIDAY INN.

Limited Space! — Contact Ronald Lubman (366-1744 or 486-6444) or

Revised Information
on Mexico Trip

ITINERARY:
ACAPULCO
ONLY

Date: January 15—22, 1977
Please note this January 15 departure
date supersedes the previous Jan. 14

date.

7 Nights at Acapulco’s
Deluxe Hotel

HYATT REGENCY
INTERNATIONAL

Airline: United Airlines

Price: $499 includes 5 days MAP (breakfast
and dinner)
Covers all Hyatt Regency restaurants
except for surcharge of $4.00 at the
gourmet EL PESCADORE and $6.00
surcharge at NUMERO UNO, which
includes show and dinner.

Price includes air fare, hotel, taxes, tips and
transfers,

Deposit of $100 per person required.

ACT FAST
Space is limited
CUTOFF DATE IS
NOVEMBER 10.

MPhA office (727-0746).

A-200 PYRINATE KILLS'EM DEAD.

Why bother stocking anything else?

Crabs, head and body lice, nits — the
only medicine anyone needs to stop them
dead is A-200 Pyrinate, the No. 1 lice
killer. It has the highest turnover rate of
any pediculicide.

At $2.29 suggested retail, A-200
Pryinate means excellent profit for you.
And it’s non-prescription, which means
good walk-in business. It’s advertised in
college and underground papers. And this
year, the Lice Alert Hotline Program will
make people more aware than ever of
A-200 Pynnate.

Stock both forms of A-200 Pyrinate.
The Liquid is ideal for head lice. The Gel
is convenient for children,
and for treatment of crab
lice in the pubic and
hard-to-reach peri-
anal areas.

A-200 Pyrinate

is the Pharmacists’ Pediculicide. It’s the
only lice remedy you need to stock. Dis-
play it in the medicated shampoo section
for impulse purchase, and behind the
counter for your own recommendation.
LICE ALERT HOTLINE: When
lice strike, call us toll free at 800-431-1140,
Once the outbreak is verified, we'll
swing into action with a whole program
designed to stop an outbreak before it
gets rolling. And to thank you for your
quick thinking, we'll send
youagift youcan use in
your professional _
practice. 3

tg

Lice Medicine

© 1976, Norcliff Thayer Ine.

Dr. Abbott: There’s more than just his initial on our products.

( [= One thing you could count on with
= W.C. Abbott, M.D.: whatever he did,
he’d exceed specs. There were no halfway measures,

compromises or middle ground in his scheme of
things. One hundred percent was the baseline where
one began, not a goal.

When Dr. Abbott founded the Abbott Alkaloidal
Company in 1888, /iterally an era marking the
beginning of modern medicine in North America,
he set forth stringent manufacturing principles that
are as valid today as they were when he made up
and sold his first eight dollar order.

ABBOTT LABORATORIES North Chicago, IL 60064

Historically, Abbott Laboratories has been a
pharmaceutical industry innovator in manufactur-
ing techniques, quality control, sales systems and
distribution efficiencies.

Today Abbott is more than a half dozen divisions
.. . nationwide, worldwide. Sales exceed a billion
dollars annually. Yet you can be sure that as long
as Dr. Abbott’s initial appears on every product
we make, the uncompromising quality
physicians, pharmacists and patients
have learned to expect, will be there.

ABBOTT

6063 162

LEARN and BENEFIT... From The Experts

n> ri

_THE MARYLAND PHARMACEUTICAL ASSOCIATION

al i
eres

re

ue, SE Ge Pop a

,

REGISTRATION FORM

MACY ECONOMICS SEMINAR

ke check payable and send to MPhA, 650 W. Lombard St.,

Competence For All Pharmacists —

“Clinical Pharmacy” As Standard of Practice
An Editorial

Drug Evaluation — Oxybutynin Chloride
John Hoopes

Pharmacist — Agent For Communication
in the Health Care System

THE MARYLAND PHARMACIST

650 WEST LOMBARD STREET

BALTIMORE MARYLAND 21201 Nee”

TELEPHONE 301/727-0746

OCTOBER 1976 VOL.52 == NO.10 : el
- ee ——— = SSSS== = a - — — — = :

CO NTE NTS NATHAN |. GRUZ, Editor :
—s mm pv uy Pg SMM gh IE us amen RICHARDENA TE GCHILIC? 4 corer ar taeennanm |
Editorial ABRIAN BLOOM, Photographer

6 Competence For All Pharmacists — ‘‘Clinical Pharmacy” As

. OFFICERS & BOARD OF TRUSTEES
Standard of Practice 1976-77
— Nathan I. Gruz Honorary President

MORRIS LINDENBAUM
7 President
Articles ; MELVIN N. RUBIN—Baltimore
12. The Colonial and Revolutionary Heritage of Pharmacy in ;., Pare
America — The Colonial Practice of Pharmacy STANLEY J. YAFFE—Odenton

. Treasurer
— David L. Cowen ,\Ony G. PADUSSIS—Timonium

cro j j j eHealth Care &xecutive Director
15 Pharmacist — Agent For Communication in the He NATHAN TE GRUZ = Bete
System

— Richard M. Schulz TRUSTEES

HENRY G. SEIDMAN, Chairman
Departments Baltimore

LEONARD J. DeMINO (1978)
Zine ealendar Wheaton

; S. BEN FRIEDMAN (1979
8 Drug Evaluation — Oxybutynin Chloride (Ditropan®) Patoriae ne)

—John Hoopes — RONALD A. LUBMAN (1979)
Baltimore

25. Open Forum ROBERT J. MARTIN (1977)
oa ; : LaVal
17 Continuing Professional Education 1976-1977 JERRY OVERBECK (1978)
21,23 News aarSe uty

VINCENT DE PAUL BURKHART (1977)

31. Obituaries

EX-OFFICIO MEMBERS

ADVERTISERS WILLIAM J. KINNARD, JR.—Baltimore

ROBERT E. SNYDER—Baltimore

14, 26 Burroughs Wellcome 7 Mayer & Steinberg, Inc.
11. Calvert Drug Company 22 Merck Sharp & Dohme HOUSE OF DELEGATES
ae Speaker
2 p
27 2Jetes Photo ne 32 Norcliff Thayer VICTOR H. MORGENROTH, JR.—Ellicott
18-19 Geigy Pharmaceuticals 24 Paramount Photo Service City
20 The Henry B. Gilpin Company 29 Parke-Davis Vice Speaker
9-10 Lederle Pharmaceuticals 4-5 Roche Laboratories ees LICHTER—Randallstown
ae. ecretary
3 Eli Lilly & Company, Inc. 33 A. H. Robins NATHAN I. GRUZ__Baltimore
30 Loewy Drug Company 16 Smith Kline & French Laboratories

28 Maryland News

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THE MARYLAND PHARMACIST

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editorial

COMPETENCE FOR ALL PHARMACISTS—
“CLINICAL PHARMACY” AS STANDARD OF PRACTICE

The issue of recognition of ‘‘clinical pharmacy practice as a
specialty’’ has been strenuously debated for some time. The
American Pharmaceutical Association’s Academy of Pharmacy
Practice (APP) has established a “Section on Clinical Practice”
and the section’s officers are considering the advisability of
petitioning the Board of Pharmaceutical Specialties for recogni-
tion.

Wouldn’t the profession of pharmacy and the public interest
be better served at this time by working for the establishment
and implementation of standards of practice that include most
of what is being advanced by many as ‘‘clinical pharmacy’’?

Gary W. Cripps, Pharm.D., Chairman, APP Section in Clinical
Practice, has focused on this as follows:

Most would agree that the functions of clinical pharmacy
practitioners in community, hospital, and organized health
care settings should include the following:

1) Obtaining and maintaining a patient data base for use
in making pharmaceutical decisions affecting patient care;

2) Advising the patient on OTC drug therapy;

3) Consulting with physicians about therapeutic goals and
end points, appropriate drug therapy, and product selection;

4) Counseling patients about the proper use of prescrip-
tion medication;

5) Referring patients to appropriate health care personnel
based upon problem assessment;

6) Safely dispensing, distributing, and administering
medications to patients;

7) Identifying toxic manifestations of drugs and taking

appropriate action;

8) Serving as a source of health and drug information for
patients and other health professionals;

9) Conducting drug utilization review programs within
their practice area;

10) Carrying out programs to ensure patient compliance;
and

11) Monitoring drug therapy to detect, correct, and pre-
vent drug-related problems, including: drug interactions,
adverse effects, lV incompatabilities, drug altered laboratory
values, contraindications, misuse, abuse, noncompliance,
inappropriate therapy, and therapeutic failures.

It is clear that by providing these services — services that
are the general basis for clinical practice intended to help
ensure safe and effective drug therapy for patients — phar-
macists can meet the needs of their patients and make a
positive contribution to health care.

Thus the major consideration appears to be, should not
these services be a component of all pharmacy practices

rather than the basis for specialization? This question is placey
into even sharper focus when one considers that existin;
undergraduate pharmacy educational programs are nowstriy
ing to develop these very same capabilities in all graduates!

Although there should be clinical as well as management
and technical aspects in all pharmacy practices, there are
pharmacy practitioners whose major efforts and responsibili-
ties primarily involve clinical functions and actitivies. Where
this is true, and the services are directed at a specific patient
type or a specific function, then there would more likely exist
a basis for specialization. Examples might include pediatric
pharmacy, mental health pharmacy, drug information, nu-
clear pharmacy, and primary and maintenance care in or-
ganized health care settings.

Many arguments can be made for and against specialization
of clinical practice on the basis of special interest versus a
specialty perse when one considers the Board of Pharmaceut-
ical Specialties’ criteria and guidelines concerning need, de-|
mand knowledge base, specialized functions, education and|
training, numbers of practitioners, and time spent in activity.
While these considerations are being debated and deliber-
ated, should not our major effort be directed toward promot-
ing and developing these basic clinical services as standards
of practice based on competence for all pharmacists, rather
chan as the basis for specialization? Furthermore, might not
specialization even deter the expansion of the use of these
concepts in every pharmacy practice? :

There are obviously a number of unanswered questions.
about whether or not clinical pharmacy per se deserves rec,
ognition as a pharmaceutical specialty; but whatever the
eventual answers may be, those areas within clinical practice
which meet the Board of Pharmaceutical Specialties’ criteria
for recognition of a specialty should be identified and prac-
titioners encouraged to seek specialty recognition."

Perhaps suitable recognition for these pharmacy practition-

ers who demonstrate competency in providing pharmaceutical
services based on meaningful standards of practice should be
the goal of organized pharmacy. An important end result could
be of practical concern: the realization of the value of such
I services and equitable compensation to the pharma-
cist providing such services.

“clinica

— Nathan I; Graz

"Gary W. Cripps, Pharm.D., ‘Is Clinical Pharmacy Practice a Phar-
maceutical Specialty?,”” American Pharmaceutical Association Academy
of Pharmacy Practice, Pharmacy Practice. Vol. 11 (No. 10), October,
1976. pp. 2, 3.

THE MARYLAND PHARMACIS1

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DRUG EVALUATION

OXYBUTYNIN CHLORIDE

by John Hoopes, Pharm.D.*

INDICATIONS:

Oxybutynin chloride (Ditropan®) is indicated for the relief of
symptoms associated with voiding in patients with uninhibited
neurogenic (UNB) and reflex neurogenic bladder (RNB).

Absorption, Distribution, Metabolism, Excretion:

Oxybutynin chloride is rapidly and efficiently absorbed from
the small intestines as are other tertiary amines. It reaches peak
serum levels at approximately two hours. It is extensively
metabolized, the extent varying with the animal studied. In the
dog, only 1% is recovered unchanged in the urine in 48 hours
(1). Kinetic data in humans are not available.

Pharmacology:

Oxybutynin is a tertiary amine having qualitatively different
effects than other anticholinergic agents. Animal studies indi-
cate that oxybutynin is considerably less potent than atropine in
cholinergic-induced hyperactivity of the jejunum, colon and
detrusor muscle. Fredericks et al (2) found it to be "/13 as potent
as propantheline and % as potent as atropine. Similarly it is less
potent than atropine in suppression of salivary and gastric acid
secretion, as a mydriatic, as a cardioaccelerator and its central
nervous system effects (1).

Oxybutynin is, in vitro, twice as potent as atropine in inhibit-
ing morphine-induced spasms of the colon and 10 times more
potent in the inhibition of barium chloride-induced spasms of
the detrusor muscle (1, 2,3).When compared to propantheline,
oxybutynin has been shown to be twice as potent in inhibiting
barium chloride-induced spasm of rabbit detrusor muscles (2).

Oxybutynin has been shown to have analgesic potency
equivalent to aspirin in the rat acetic acid stretch test, anda local
anesthetic activity on the rat cornea twice that of lidocaine (1, 3).

CLINICAL STUDIES:

Diokno and Lapides (4) reported a beneficial effect of
oxybutynin (5 mg. twice daily) in controlling the symptoms of
urinary frequency, urgency and incontinence associated with
UNB. Cystometrograms of patients treated with oxybutynin
compared with propantheline showed equivalent responses.
The response from oxybutynin was of a longer duration. Pa-
tients with urethralgia and vesicalgia secondary to infection,
irradiation, and transurethral resection experience symptoma-
tic relief from oxybutynin. No changes in liver function tests,
kidney function tests or in the hematopoietic system were
noted in patients treated for months (exact length of study was
not stated).

The remainder of clinical studies available for review on the
antispasmodic activity of oxybutynin in the treatment of

8

neurogenic bladders comes from the manufacturers (3). Thei)
studies demonstrate a statistically significant difference in the
cystometry results of patients with UNB or RNB on oxybutynir
(5 mg. t.i.d.) as compared to those treated with propantheline
(15 mg. t.i.d.). The results of cystometry indicate an improve.
ment in mean bladder volume at onset of first contraction, in
mean bladder volume at end of cystometry, and in mean blad-
der volume at first desire to void. Their studies further demon-
Strate a statistically significant difference in favor of oxybutynin
over propantheline in the response of pain, urge incontinence,
and nocturia.

Similar results have been demonstrated in children with UNB
or RNB comparing oxybutynin (5 mg. twice daily) to placebo.
Five children previously treated unsuccessfully with imipramine
or propantheline were also included in the study. All children
experienced a reduction in daytime frequency and inconti-
nence. Nocturnal incontinence and frequency were similarly
affected.

Anticholinergic side effects are experienced with oxybutynin
despite its low activity in this regard. They appear to be lower in
frequency than what would be expected from equipotent doses
of propantheline but comparative data are not available. In a
series of 25 patients treated for 30 days, side effects were expe-
rienced in 8 patients (32%) and therapy was discontinued in 3 of
them (2—nausea and 1—sore throat with dry mouth). Hock (5)
reports that in doses of 10 mg. daily, 8 of 44 patients (18.2%), and
in doses of 15-20 mg. daily, 21 of 26 patients (80.8%), expe-
rienced side effects. Visual complaints were manifested at
doses of 20 mg. daily. In 11 of 346 patient trials (3.2%), side
effects were severe enough to warrant discontinuance of the
drug (3). Overall, the most frequent side effects experienced
were dry mouth, nausea, slowing of urinary stream, blurred
vision, tachycardia, palpitations and heartburn. Ages of the
subjects were not listed. The exact frequency in this overall
analysis is not clear.

In studies done by the manufacturer, no effect on the
metabolism of phenobarbital, diphenylhydantoin, warfarin,
phenylbutazone or tolbutamide could be demonstrated.

(Continued on Page 11)

TA neurogenic bladder is a term used to describe abnormalities in the
urinary bladder resulting from deficiencies in neurological control.
UNB is a neurogenic bladder resulting from a net loss in voluntary
control. RNB is a neurogenic bladder resulting from a total loss of
sensory and motor communications with voluntary centers.

“Dr. Hoopes is Assistant Professor, Division of Clinical Pharmacy and
Department of Family Medicine, University of Maryland.

THE MARYLAND PHARMACIST

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Drug Evaluation (Continued from Page 8)

LONG TERM SAFETY:

The manufacturer has long term safety data on 128 subjects
over periods of 7 days to 8 months. No abnormal organ function
or enzyme activity was attributable to the drug in these studies.
No long term safety data is presented specifically for children.

DISCUSSION:

In vitro studies indicate that oxybutynin has activity against
spasms induced by stimuli other than cholinergic agents (mor-
phine and barium chloride). Analgesic and anesthetic actions of
the drug have also been documented in animals. These
properties are distinctly different from other anticholinergics.
The above activities of oxybutynin may account for the clinical
differences demonstrated for the drug. However, these specific
effects have not been demonstrated in humans.

Uninhibited neurogenic bladder is a result of a net loss of
inhibitory influences on the bladder. Sensory impulses remain
intact. Lesions exist either in the spinal cord or in the upper
motor neurons (the brain) and result from a wide variety of
etiologies. The patient senses a full bladder only just as it
reaches capacity. Capacity is reduced and spasms are induced
causing symptoms of frequency, urgency, urge incontinence
and pain. The voiding contractions are re-enforced by parasym-
pathetic stimulation. Anticholinergics are therefore indicated to

control symptoms. Oxybutynin (5 mg. t.i.d.) is useful in the
symptomatic control of this problem.

Reflex neurogenic bladder results from functional or struc-
tural transection of neural tracts above the sacral segments. The
resultis aloss of all sensory and motor communications with the
voluntary centers. Urination occurs involuntarily. In many pa-
tients with UNB and in nearly all patients with RNB, there is
associated dysfunction of the external sphincter (somatic motor
innervation). Since anticholinergic agents have action only on
bladder (detrusor) musculature, these agents play only an ad-
junctive role in the management of such patients.

Frequency, urgency, incontinence, dysuria, and nocturia are
associated with many types of bladder problems. UNB and RNB
are only two of many possible causes of these symptoms and are
diagnosed only through cystometry. Patients presenting with
these symptoms need adequate investigation into the etiology.
Itis the etiology which defines the treatment, not the symptom.

Finally, the claim that oxybutynin compared in equipotent
doses with propantheline has less frequent side effects is not
well documented. From the data available it is this reviewer's
opinion that at equipotent doses side effects occur with equal
frequency but the severity may be less with oxybutynin.

Data are available regarding acute and chronic overdose in
humans although anticholinergic effects would be expected to
predominate. The Maryland Poison Information Center should
be consulted in such situations.

(Continued on Page 29)

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OCTOBER, 1976

17

The Colonial and Revolutionary Heritage
of Pharmacy in America

by David L. Cowen*

The Colonial Practice of Pharmacy — Part |

The traditional services of the pharmacist — the pro-
curement, preservation, preparation, compounding and dis-
pensing of drugs and medicines — were practiced, in whole or
in part, by four different functionaries in the American colonial
period. They were the physician, the apothecary, the druggist,
and the merchant. Each in some way differed from the pharma-
cist that developed in the nineteenth century but each contrib-
uted to the evolution of the American pharmacist.

THE PHYSICIANS

As was noted in the previous selection, few trained prac-
iitioners of pharmacy were to be found in the early colonial
period, and indeed throughout the entire colonial period.
Medicine and pharmacy were not separated; the physician
practiced pharmacy and the apothecary practiced medicine. It
was in fact not easy to distinguish between the two; what they
called themselves and whether they put their primary emphasis
on medicine or pharmacy determined which was a physician
and which an apothecary. Moreover, there was an easy fluidity
from one calling to another that reflected the frontier condi-
tions of the colonies and the professional freedom permissible
under the British system. John Johnstone’s rapid progress from
‘druggist’ to “apothecary” to “doctor” was noted in the pre-
ceding selection.

The practice of pharmacy was part of the practice of all the
physicians, the best trained and the virtually untrained. Zabdiel
Boylston, one of Boston’s foremost physicians, regularly adver-
tised his drugs in the newspapers in the early 1720’s. Where
elsewhere physicians could have used the scarcity of Competent
apothecaries as an explanation for their pharmaceutical activity,
that was not the case in Boston. A contemporary of Boylston
pointed out that there were 14 apothecaries in the city and yet
“all our Practitioners dispense their own medicines.”

The first provincial medical society, the New Jersey Medical
Society, promulgated a fee bill as one of its first activities in 1766.
That bill allowed the physician no fee for visits in town; that is,
his diagnosis and advice were free. His income was derived
from surgery and from the medicines he dispensed. The first
American price list for drugs is the 1766 fee bill of a medical
society! (Prices varied from 1 shilling for a dose of anodyne pills
to an expensive 7s6d. for a decoction containing one ounce of
Peruvian bark.) A decade earlier the Charleston, South Carolina
Faculty of Physic had rejected the New Jersey scheme — they
felt there should be payment for each of their functions.

“David L. Cowen is Professor of History at Rutgers, the State University
ot New Jersey.

Reprinted with permission of the author and The New Jersey Journal of
Pharmacy.

12

a

The New Jersey fee bill makes it abundantly clear that is was)
not pre-packaged medicines that the physician handled. The list.
included virtually every dosage form: boluses, decoctions,
electuaries, draughts, elixirs, powders, pills, ointments,
tinctures.

Some physicians, and probably apothecaries who called
themselves physicians, operated ‘‘doctor’s shops.’’ The famous |
Hugh Mercer, who left his medical practice in Fredericksburg to |
die, a patriot General, at the Battle of Princeton, ran such a
shop. The 1762 newspaper advertisement that offered “a com-
plete and valuable Shop of Medicines with Mortars and sundry
Instruments and other Things, very suitable for a Doctor’ illus-
trates how commonplace a physician’s pharmaceutical practice
must have been.

THE APOTHECARY

The British apothecary had his right to diagnose and pre-
scribe, that is to practice medicine, legally recognized in the
famous Rose case of 1703. In America the apothecaries arro-
gated unto themselves the same privileges, and certainly the
same argument used by the British, namely, that there were not
enough qualified medical practitioners to meet the needs of the
public, was valid in America.

There is indication that the apothecary in America trained
apprentices and that there were therefore some specialists in
pharmaceutical techniques in the colonies. A Virginia statute of
1736 distinguished between the qualified physician and the
apothecary who had “served an apprenticeship to the trade.”
(The. distinction was made for fee purposes: the apothecary
could charge only about half as much as the physician for the
same services.) In 1766 Thomas Boulton was apprenticed to the
Pennsylvania Hospital ‘‘to learn the art, trade and mystery of the
apothecary.”

Although there were apparently an increasing number of
apothecaries as the colonies became more populated — wit-
ness the 14 in Boston in the 1720’s — they are clouded in
considerable confusion. Perhaps this is because many turned
into physicians, as did Bartholomew Browne of Salem, Massa-
chusetts, or, conversely, because men who started as mer-
chants later considered themselves apothecaries, as Carl
Heinitsch of Lancaster. But the names of a good many are
known. Among them, Frederick Otto, who arrived in Lititz,
Pennsylvania in 1760 where the local regulations granted him ae
monopoly. “No other persons shall in any sort meddle with
Store or Shop-keeping or exercise the business of an Apothe-
cary,’” ran the statute in that Moravian town. One of the most
famous was Christopher Marshall, who started a pharma-

THE MARYLAND PHARMACIST

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Ditto Hordear. Tin@ura. Hordeum Perla, »'
Celeitis. Coriand. Sem. Hord Gall. 2
Epidemica. Ca Rats. Hypociltisfuegy .
Fortis. 4 Ok Gd Alap Rade te |

America’s first separate publication of a pharmacist, Talbot’s Catalogue ca. 1725

ceutical dynasty in Philadelphia that was to play an important
role in American and pharmaceutical history.

The apothecary often played the role of wholesaler —a role to
be assumed by the druggist — and there are records of apothe-
caries offering to sell ‘the best medicine at the most reasonable
rate . . . to town and country physicians.”

But the best account we have of the practice of the colonial
apothecary, and his essentially pharmaceutical role, comes
from the records of Robert Talbot, apothecary in Burlington,
New Jersey. Talbot died in 1725 and just before (although possi-
bly after his death there appeared “A Catalogue of Medicines
Sold by Mr. Robert Talbot of Burlington,” which is the first
separate publication by a pharmacist in British North America.
This, plus the detailed inventory of his estate taken on March 14,
1726/7, tell us a great deal about the apothecary’s activity. In the
first place, his medicines were essentially like the stock of any
European apothecary; there were very few drugs of North
American origin. Most of them were of vegetable origin, a few
of animal origin. A few chemicals were included — sal am-

OCTOBER, 1976

moniac, tartar, epsom salts, vitriol — but many minerals and
mineral compounds. His supplies of arsenic, antimony,
calamine, flowers of sulphur, rock alum, bole Armenic and
litharge were large. The last probably indicates that he made up
the plasters that appeared on his inventory and it is likely as well
that the elixirs and spirits on his list were also put up by him.

But perhaps most interesting was Talbot’s equipment. Along
with the usual mortars and pestles, scales, tiles and bottles of
many sizes, Talbot had a ‘“‘Chafin dish” of about 100 pounds,
two small copper stills, 17 cedar drug tubs, 27 small crucibles, a
four-pound infusion pot, two copper pans, one copper funnel,
three glass funnels, and sundry “Receivers,’’ ‘Upright Bodys,”’
“Crook Necks,” and ‘‘Blind Heads.” Clearly Talbot's practice
indicated that he was a rather large-scale practitioner of the art
of the apothecary and that a great deal of that art required
manipulation.

Part II will be published in a later issue.

iis:

ANNOUNCING:

THE NEW
“RETURNED GOODS”
POLICY FROM
BURROU OME CO.

Wr

ase)
Lenses
.

ar WAS,
7

o'
5en

yr

—— veya w oe mecneeesom DAOUE CAT:
= Te wes ™ 3 DN US er et nt at te tr =" +t
Se

4 a sistmisy si ua :
(==> hd Lo
In our continuing effort to help make your This liberal “Returned Goods” Policy
use of our pharmaceuticals more convenient: means you deal directly with the
e@ B.W. Co. now accepts the direct return Company, not with your wholesale
of all B.W. Co. products, regardless of distributor.

date of manufacture

For full details, please contact your
e B.W. Co. now accepts open bottles with P y

partial contents for exchange B.W. Co. Representative or write:

e B.W. Co. now replaces returned goods Burroughs Wellcome Co., Claims and
with pr fie ae amount of B.W. Co. Adjustments Department, Box 1887,
high volume merchandise of -

Patmceiection Greenville, N.C. 27834.

@ B.W. Co. now reimburses you with Burroughs Wellcome Co.
additional products for all postage Be Research Triangle Park
costs incurred Wellcome | North Carolina 27709

Pharmacist
Agent For Communication in the Health Care System

by

Richard M. Schulz, R.Ph.

The change of season provides a backdrop in which the
pharmacist is seen in his continuing role of health educator.
_ Whether the malady be summer sunburn or seasonal sniffles,
the patient approaches the pharmacist as the most accessible

person in the health care field. Dr. Kenneth Kirk stated in the
September issue of The Maryland Pharmacist that the pharma-
cist has the opportunity to interact with the patient in all five
stages of illness. In fact, no other health professional can claim
this position. This element of pharmacy practice supports the
Millis Commission’s recommendations to colleges of pharmacy
to incorporate social sciences as a vital part of the students’
*curriculum. These opportunities could result in the genesis of a
new pharmacist, molded by today’s needs and tomorrow’s
projections. He or she is not entirely unique, but uniquely
effective in answering the needs of the patient. The pharmacist,
in effect, will be the communicative agent for the health care
system.

Although our knowledge is primarily centered around the
tablet or the teaspoon of medication, our emerging area of
expertise must be in communication. The lawyer who is a mas-
ter of the law yet deficient in its practice is in the same predica-
ment. The fact that the pharmacist is in a favored position is
merely wasted rhetoric unless he has the ability to engage in
meaningful and informative dialogue on the appropriate level.

Certainly consultation about sunburn does not grant a posi-
tion of prestige to the pharmacist. However there are situations
that occur on a daily basis in which appropriate professional
intervention is warranted and desperately needed:

® A nineteen-year-old male approaches the prescription

counter to pick up a refill for his mother for methotrexate.
He asks what the medication is for. What do you say? Do
you give him an answer that possibly his parents do not
want him to know? Do you ignore him or cursorily dismiss
the query?

© A fourteen-year-old girl nervously approaches your young

female pharmacy aide and asks for a contraceptive vaginal
suppository and a douche. You overhear the conversation
and must decide whether to sell contraceptives to patrons
of that age. If you decide “yes”’, then should you intervene
and tell her about the various over-the-counter contracep-
tive measures that are relatively more effective?

® Apersonal friend for many years has suffered the tragedy of
losing a son or daughter in an automobile accident. The
parent was given a minor tranquilizer to be taken when
needed for nerves and depression. Your refill record shows
that the dosing frequency has increased to a dangerous
level. What do you say? Do you remain silent and wait for
the ‘‘traumatic’’ period to pass?

OCTOBER, 1976

There is amuch deeper issue than is readily apparent in these
examples. Obviously there is no right or wrong answer. One's
decision to actively intervene is directly affected by the circum-
stances of that particular situation. The central issue here is not
the pharmacist’s factual knowledge about methotrexate or con-
traceptive suppositories. We must focus not only on what the
pharmacist says, but how he says it. The ability to communicate
is a skill that can be learned and improved. It serves no purpose
for the pharmacist to counsel a patient if the message is directed
to an anonymous creature on the other side of the counter:

The list of variables making each person unique is seemingly
endless. An evaluation of present psychological and emotional
make-up, educational level, stage of illness, and sociological
background should help determine the mariner in which you
communicate your message. For some people, a diuretic’s ac-
tion should be described as an “increase in urination’. For
others, being told they will “make more water than usual” is
appropriate because it is the level they can most easily under-
stand. A hospital pharmacist practicing in an anti-coagulant
clinic must judge the patient's ability to comprehend the ter-
minology before explaining the do’s and don't’s of self-
medication.

It is well documented that much of the communication be-
tween physician and patient is not understood or retained by
the patient. We are also aware that the patient responds favor-
ably to a pharmacist who shows the interest and concern to fill
this information void. Because of the pharmacist’s unusual posi-
tion in being easily accessible and his vantage of observing all
stages of illness, and his acceptance as a health professional, he
can become liaison between physician and patient as well as
serving as the provider of pharmacy services. As an agent for
communication, the pharmacist, through appropriate interven-
tion, ensures a more personalized quality of health care.

*Mr. Schulz is a practicing community pharmacist and Assistant
to the Executive Director of The Maryland Pharmaceutical Asso-
ciation.

ACKNOWLEDGEMENT

Credit is due Paramount Photo Service for all of the

photo coverage of events in the July issue and of the
MPhA Convention published in the August issue.

15

RAY HECKMAN

DEAN SULLIVAN

Lu and A
GORDON KNIGHT

DEE LoOONG

JOHN O'MALLEY

BOB GITTINGS < ch
TOM DONOVA

BOB MUMMEY TIM BRODERICK

WE'RE PUTTING
OUR BEST FACES FORWARD

The faces of SKGF Representatives who stand ready

to help you in any way with anything to do with SKGF.

If you have a question or a problem, just ask.
2

Smith Kline & French Laboratories VW)

Division of SmithKline Corporetion

CONTINUING PROFESSIONAL
EDUCATION 1976-1977

UNIVERSITY OF MARYLAND SCHOOL OF PHARMACY
PHARMACY SELF-STUDY COURSES AND SEMINAR PROGRAM

#176 REQUESTED TOPICS SELF-STUDY COURSE

(NEW, IMPROVED STUDY SERIES)

Series consisting of six frequently requested topics:

Diabetes Mellitus

Vitamins

Patient Records — Patient Consultation

Managing Analgesics

Psychiatric Disorders (Neuroses Depression, Schizophrenia)
Bioavailability

not WH

Each unit will consist of a booklet containing a concise, clear
discussion of the topic. At the end of each booklet there are 30
multiple choice questions drawn directly from the discussion
material. Complete the answer sheet and submit it to the School
for grading. All discussions and tests have been pre-evaluated
for content and clarity. When you have completed all six as-
signments, you will receive a certificate and Continuing Educa-
tion credit for relicensure (1.2 CEU/12 hours) as needed.

While the course is primarily self study, discussion sessions
will be held at the School of Pharmacy in Baltimore and also will
be arranged on a special rotating site basis on the Eastern Shore
by Dr. Tom Sisca. Applicants who wish to attend the Eastern
Shore sessions are advised to contact Dr. Sisca at the Easton
Memorial Hospital, Easton, Maryland, (301) 822-1000.

The Baltimore sessions will be held on Tuesday and Wednes-
day evenings 7:00 p.m. to 9:00 p.m., Room 201, Allied Health
Professions Building, School of Pharmacy.

Date of the Baltimore Sessions:

November 16 & 17, 1976 February 15 & 16, 1977
December 14 & 15, 1976 March 15 & 16, 1977
January 18 & 19, 1977 April 19 & 20, 1977

Registration Fee: Attending Discussion Session — $35.00

Self-Study Only — $30.00

Resource individuals will be available for consultation at the
School of Pharmacy at selected times.

Text: ‘Applied Therapeutics for Clinical Pharmacists’’ may be
used for correlated study.

#276 APPLIED THERAPEUTICS FOR PHARMACISTS

A repeat of last years course (omitting contraceptives) consist-
ing of six (6) topics:
Parkinsonism
Angina
Peptic Ulcer Disease
Poisonings
Urinary Tract Infections
Congestive Heart Failure

nut wh

OCTOBER, 1976

This course will be self study only, no discussion sessions.
study guides and questions will be mailed together at four week
intervals. Self study tests have been revised based on last year’s
experience.

Resourse individuals will be available for consultation at the
School of Pharmacy at selected times.

Text: “Applied Therapeutics for Clinical Pharmacists”’

Registration Fee: $55.00 including text

$35.00 without text

#476 THE USE OF AUXILIARY LABELING SYSTEMS FOR PRO-
VIDING PATIENT INFORMATION

To be presented in cooperation with the Maryland Phar-
maceutical Association and local pharmaceutical groups.

Prompted by increasing concerns demonstrated by non-
compliance of patients with prescription regimen, patient er-
rors in medication use, drug reactions and interactions, and the
resulting escalation of human suffering and costs, a special
committee at the School of Pharmacy was charged to deal with
this subject. The committee, under the direction of Dr. Ralph
Shangraw and Mr. Donald Fedder, has developed procedures
which will hopefully create interaction of the pharmacists with
the patient to provide proper patient care. This program will be
presented at seven locations throughout the state in conjunc-
tion with meetings of local pharmaceutical associations as fol-
lows between January 1 and April 1, 1977.

1. Allegheny-Garrett County Pharmaceutical Association

. Baltimore Metropolitan Pharmaceutical Association

. Eastern Shore Pharmaceutical Society

. Anne Arundel County Pharmaceutical Association

. Prince Georges-Montgomery County Pharmaceutical
Association

6. Washington County Pharmaceutical Association

7. Upper Bay Pharmaceutical Association

Mm BW Nd

Dates and sites of the meeting will be announced.

Registration Fee: There will be no charge for this special
program.

Handouts: Informative handouts will be distributed at the
meetings.

Continuing Education credits will be granted for these pro-
grams.

The meetings will be presented by members of the School of
Pharmacy faculty and local pharmacists using systems.

(Continued on Page 29)

17

You cant beat cheap labor.

Introducing Datarex;° a remarkable new inventory management system specifically
designed to get you out of the day-to-day problems of inventory control.
It not only does a lot of your work cheaper than you can do it yourself,
it probably does it better.
Take price stickers. You may be losing 2% or more of your bottom-line
profits now because your stickers are out of date. Datarex® keeps you
up to the minute— automatically.
You're probably losing 15% of your possible sales because of outs.
” «(atarex” shelf labels and the Datarex” in-store computer put
an end to outs—again, automatically. (The com-
puter, by the way, can transmit most orders
in less than a minute.)
You probably don’t have time right now to
analyze your profits item-by-item. Datarex®
_ Management reports can give you an in-depth
_analysis of volume and profits for every
_ department every month. And every quarter
you get all the same information for every
item you sell.
And talk about cheap labor: a Datarex®
em can cost as little as $50 a month. And
| be completely tailored to your exact
ications, so you won't have to pay a
for any service you don’t need. What’s
it can be operated by anybody you have
for you. There’s no need for expensive
labor.
d keep this in mind, Datarex® has the
to drastically reduce lost sales, thus
maximizing your return on your investment.
_ How can we do it at this price? We figure
got to. We're a full-service wholesaler
ve want all your business. A// of it. We
fford to charge you too much for a
item or service.

So call your Gilpin
wholesaler today. Just
tell him you want out
of inventory and into
management, where
you belong. Tell him
you want to know
more about Datarex®

You can’t beat the
system: The Datarex”
System from Gilpin.

THE HENRY B.
: COMPANY
: 901 Southern Avenue

Washington, D.C. 20032
Phone (301) 630-4500

Vice President Retailer Services
I want to know more about the system. Send me
your free Datarex® booklet.

Name

Firm

Address eee ;
City State Zip

Geet ee ee Se ee ee eee Ge ee mee em a all

7
I
I
| I
Attention Harrison L. Leach I
I
i
|
i
|
|
l

NeUWTs

Flu Immunization Campaign
BMPA Meeting Feature

Photo Paramount Photo Service

DR. MARK GOLDBERGER

Dr. Mark Goldberger, Deputy Chief, Division of Communi-

_ cable Diseases and Epidemic Intelligence Officer for the Mary-
_ land State Department of Health and Mental Hygiene, was the
_ featured speaker at the September 28 meeting of the Baltimore

Metropolitan Pharmaceutical Association. Ronald Lubman,

_ President of BMPA, presided at the meeting held at the Quality

Inn in Pikesville at 8:30 P.M.
Dr. Goldberger reviewed the history of flu epidemics and

explained the various kinds of strains which presented prob-
lems in immunization. The presentation which included infor-

mative slides on the epidemiology of influenza virus provided a

~ comprehensive understanding of immunization for pharma-

cists.

At the business meeting which followed, the agenda included
reports of the President, Executive Director Nathan Gruz, as well
as the following reports: Public Relations, Charles Spigelmire;
Small Business Advisory Committee, Milton C. Sappe; status of
Medicaid MAC, MPhA President Melvin Rubin, who also re-
ported on the MPhA Industrial Relations Committee; Paul
Freiman spoke of the work of the MPhA Consumer Affairs
Committee.

There was considerable discussion of problems involving the
use of multi-scripts and payment from HMO’s for pharmacy
service. The meeting was adjourned at 11:00 P.M.

OCTOBER, 1976

November Designated Diabetes
Detection Month

The American Diabetes Association has designated
November as Diabetes Detection Month. The Maryland Affiliate
of the national group will, on request from various organiza-
tions or companies, handle diabetes detection sessions for that
particular group. Literature is also available on request. Corre-
spondence should be sent to:

American Diabetes Association
Maryland Affiliate, Inc.

3701 Old Court Road
Executive Park, Suite 19
Baltimore, Maryland 21208

Anne Arundel County
Pharmaceutical Association

The Anne Arundel County Pharmaceutical Association held
its first fall dinner meeting on September 30 at the Empire
Towers in Glen Burnie. After a cocktail hour and dinner, and
with members of the executive board of the Anne Arundel
County Medical Society in attendance, an informative lecture
and discussion on the topic of drug bioavailability was con-
ducted by Dr. William Crouthamel, Ph.D., Associate Professor
of Pharmacy at the University of Maryland School of Pharmacy.
Following a lively question and answer period, a short business
meeting was held with Vice President Vince Regimenti presid-

ing.

callencar

r

December 2 (Thursday) — MSHP, Good Samaritan
Hospital, 7 P.M.

1977

January 15-22 — MPhA trip to Acapulco

February 13 (Sunday) — BMPA Annual Banquet and
Dance, Bluecrest North

March 5-13 — MPhA skiing trip to Vail, Colorado

April 14 (Thursday) — MPhA Regiona! and House of
Delegates Meeting

May 15-19 — APhA Convention, New York City

June 19-22 — MPhA Annual Convention, Carousel
Hotel, Ocean City, Maryland

21

noncompliance:

a complication’ that too often
accompanies hypertension

Perhaps because he usually does not feel any
symptoms of the disease, the hypertensive patient
is particularly likely not to take his medication

as prescribed.

The pharmacist
can helo make a
Cifference

A professional concern:

The pharmacist can often help in the task of
motivating the hypertensive patient to comply

with the therapeutic regimen. The pharmacist, too,
may educate...encourage...remind. Your
efforts—in ways such as these—can frequently
help assure compliance with therapy.

To help, Merck Sharp & Dohme would like to
supply you with a quantity of lay booklets,
developed in cooperation with the American
Pharmaceutical Association. They are available
from MSD Professional Representatives, or by
writing Professional Service Department,
Merck Sharp & Dohme, West Point, Pa. 19486.

MSD
MERCK

BoHMe

COMPUTERIZED PATIENT PROFILE
RECORDS SYSTEM AT GILPIN

| The Scrip Stat — Computerized Rx Company of Grand Island,
) Nebraska, has been acquired by the Henry B. Gilpin Company.
Scrip Stat, a patient profile records system company, has cus-
_tomers in 24 states and Canada. Its merger will add another
source of support to the Retailer Services Department of the
Gilpin Wholesale Drug Company. William A. Burke, R.Ph., for-
_merly President of Scrip Stat, will assume the position of Gen-
eral Manager for this new Gilpin program.
Harrison Leach, Vice President, Retailer Services said, ‘Scrip
| Stat brings to our Gilpin customers the best patient profile
| system on the market today. While simply typing the Rx label,
our customers will have their patient receipt, a daily log, a
patient record label, a prescription copy, and a computer input
copy. All of this is done in a very short period of time — saving
the pharmacist time and increasing his profits.” In addition,
Scrip Stat offers the services of the computer at a very low cost
to pharmacists. It handles Third party Administered Payments
(TAP), eliminating the extra forms, and gives professional man-
/agement tools for Pharmacy Accounting Control (PAC).

This program is already operational in Nebraska with many
, customers. Scrip Stat will start in Gilpin’s Washington and Bal-
_timore divisions with installations in Norfolk and Indianapolis to
follow rapidly as the computer programs for Third-party Accep-
| tance are cleared.

| Gilpin’s new program will be presented to its pharmacist
/ customers in phases to meet their needs on an individual basis:

DATAPAC I (Phase 1) will be an efficient time-saving profile
system only. It will offer the forms for store usage in either
snap-out or continuous styles and the pharmacist may use his
_ regular typewriter. The other two phases require the use of a pin
_feed typewriter, which will be supplied by Gilpin, to assure
proper registration for optical scanning.
DATAPAC II (Phase II) will enable users of the basic Scrip Stat
Profile System to submit their Third-party Claim through Gil-
_pin’s computer. This will eliminate the writing of extra forms
and assure faster payment. Gilpin will format these to the exact
needs of the Third-party and submit computer tape to the
_ payee. Payment will be made directly to the pharmacist.

Through DATAPAC III (Phase III), users of the basic Scrip Stat
Profile System will submit all prescriptions to Gilpin. These
programs, in addition to the Third-party services, will give them
a fullaccounting program of their prescription department ona
_ biweekly basis. A complete record of past year and current
month record of sales of the individual product, and several
other valuable management tools will be produced for the
pharmacy.
Gilpin suggests that all pharmacies enter the program in
phases, beginning with Phase |. They can purchase any phase,
but because of the simplicity, Gilpin will be able to offer the
total DATAPAC III at one-half the cost of on-line computer
programs.

Scrip Stat is another addition to the many retailer and compu-
ter services already offered by Gilpin, namely, DATAREX;
_ Micro-Info; RediMed; CARE/SPARTAN Chain Buying; Coopera-

OCTOBER, 1976

School of Pharmacy
Faculty Changes

The University of Maryland School of Pharmacy has an-
nounced faculty appointments and promotions for the
academic year.

Joining the faculty are:

Gordon A. Ireland — Appointed instructor in clinical phar-
macy in conjunction with the Veterans Administration Hospital.
He received his B.S. in Pharmacy in 1973 from the University of
Maryland and his Pharm. D. degree from the University of
Minnesota in 1976.

Thomas C. Majerus — Appointed instructor in the Division of
Clinical Pharmacy in conjunction with the Inpatient Medical
Services of the University of Maryland Hospital. Dr. Majerus
received his Pharm. D. degree from the University of Minnesota
in 1976.

Bruce Duplisse — Holding a Ph.D. in pharmacology from the
University of Arizona, Dr. Duplisse will teach physiology and
pharmacology as an assistant professor in the Department of
Pharmacology and Toxicology.

M. Antoinette Schiesler — Appointed instructor in phar-
maceutical education and director of minority programs. Ms.
Schiesler holds an M.S. degree in science education from the
University of Tennessee and is currently a Ph.D. candidate on
the College Park campus of the University of Maryland.

School of Pharmacy faculty promotions include:

Robert J. Michocki to assistant professor of clinical pharmacy
in the Division of Clinical Pharmacy.

John M. Hoopes to assistant professor of clinical pharmacy in
the Division of Clinical Pharmacy in conjunction with the Family
Practice Division of the University of Maryland Hospital.

Michael D. Loberg to associate professor of medicinal
chemistry in the Department of Medicinal Chemistry in con-
junction with the University’s Division of Nuclear Medicine.

William G. Crouthamel to associate professor in the Depart-
ment of Pharmacy.

tive Advertising and Promotional Programs; TIP TOP, in-store
accounts receivable programs; and Store Planning.and Remod-
eling Services. ‘It meets the needs of our pharmacy customers
to have the tools and ability to compete in today’s market!”
stated James E. Allen, Jr., Gilpin Executive V.P. “We intend to
continue to offer the best services and tools for the independ-
ent pharmacist. Scrip Stat Profile System has been developed by
a pharmacist, and is being used in over 100 pharmacies today.
When merged with Gilpin’s extensive systems capability it will
work to save the pharmacist time and money and to give him the
tools necessary for better professional service to his patients.”

The Henry B. Gilpin Company, with headquarters in the na-
tion’s capital now operates seven full service wholesale drug
houses, located in Atlanta, Georgia; Baltimore, Maryland;
Dover, Delaware; Indianapolis, Indiana; Memphis, Tennessee;
Norfolk, Virginia and Washington, D.C. . . . in addition to its
surgical supply and service merchandising subsidiaries in Vir-
ginia, Maryland and Indiana.

23

Big enough to
service you....

Small enough to
know you

Today...as always
...iN quality,
experience, reliability,
Paramount means
personal service and
personal contact!

2920 Greenmount Avenue
Baltimore, Maryland 21218

Phone: Baltimore — 366-1155; Washington (local call) 484-4050

Le RTM MTT NC a. ae

OPEN FORUM

Don’t Be A Dope — Don’t Be Duped!

| There are three possible reasons for pharmacists dispensing
medication on altered, forged or uttered prescriptions — av-
arice and the “I don’t give a damn” attitude are the two types
that the various Boards of Pharmacy and Drug Control Inspec-
‘tors can best treat.

This article concerns the pharmacist who wants to do the
correct thing but who comes upon a prescription that looks
good, but is uncertain regarding its validity. Naturally, | am
talking about the Bureau of Narcotics and Dangerous Drugs,
schedules II, Ill, IV, and, in some cases, schedule V drugs.

| would like to suggest the following proposals to insure a
“minimum of illegal prescriptions being filled: First and foremost
) is rule one: If you do not know either the physician's signature
and/or the patient, do not — 1 repeat — do not fill the prescrip-
tion without first checking into its validity. The reasons are
simple and are answered by questions to yourself and the pre-
-senter: Why was the prescription brought to your pharmacy? Is
the physician nearby? Does the patient live nearby? Is the drug
an abused item? Is the quantity unusual? Is the spelling of the
drug correct? Are the abbreviations in the directions correct? Is
the presenter the patient? A friend? A relative? If the answers to
the above questions are not to your liking or if, for some reason,
you are suspicious, check further.

| have found that most of the illegal prescriptions | have
encountered have come from hospitals. If | do not know the
patient when presented with a potentially dangerous, illegal, or
habit forming drug, | make it a practice to call the hospital.
Doctors’ Information or paging should be able to tell you if the
physician whose name appears on the prescription is on the
hospital staff. If he or she is a staff member, ask to speak directly
to the physician prescribing the drug and explain the situation
and circumstances in full. Believe me, they will appreciate it! If
the physician is on the staff, fine — fill the prescription. If not,
you have to decide the next step.

The other prescriptions that can be presented for dispensing
that are illegal are either stolen or “lifted”. Stolen blanks are
obtained by stealing the physician’s bag or breaking into his
_ office. ‘Lifted’ blanks are obtained by going to the physician’s

office, having him write a prescription for the patient who has
“lifted” a number of blanks while the doctor is out of the

examination room and who afterwards copies the original
word-for-word. This ‘‘lifted’’ form of false prescription is on the
rise and is the hardest kind of illegal prescription to catch
because a legal script has been written, and if you call the
physician’s office you will get a ‘‘yes’’ answer.

| had two such “lifted” prescriptions presented within one
week and | happened to know the physician’s signature very
well. In both cases | had to argue with the secretaries and in
once instance angered the physician enough for him to come to
my pharmacy to see the prescription. Much to his amazement
he had to admit I was correct.

OCTOBER, 1976

The name of the game here is perseverance. Rule three is to
check regular prescriptions for possible fraud of schedule
charges. Rule four is to watch the prescription presenter, If he
or she is paying a lot of attention to what you are doing —
beware. If he or she is waiting at the front of the pharmacy by the
door — beware. If you are told by the presenter that they have to
leave now but will come back for the script — beware.

If, while you are verifying the prescription, you are asked by
the presenter what you are doing, tell them you have to verify an
item on the prescription and proceed to do just that.

Telephoned prescriptions for schedules III, |V, and V are legal
but that does not necessarily mean that the ‘‘verifying” call you
get is. If you do get a call from a ‘‘physician”’ and the prescrip-
tion meets the criteria of doubt, call the physician back using
the Yellow Pages as your source of information. This is rule five.

Now that you have the rules to protect yourself from filling
illegal prescriptions you have the option of taking a number of
legal actions. From the least drastic to the most, they are as
follows:

1. Simply return the prescription to the presenter with little
or no explanation.

2. Return the prescription to the presenter with little or no
explanation after placing a big ‘‘X’’ mark on the prescrip-
tion to alert the next pharmacist.

3. Do not return the prescription, telling the person that
you have to verify it before returning it.

4. Do not return the prescription and inform the presenter
that you have to notify the police.

5. Do not return the prescription or even talk to the pres-
enter but call the police stating your name and location
and inform them you have a ‘‘possible” illegal prescrip-
tion.

6. Do not return the prescription or even talk to the pres-
enter and after you have called the police (using some
pretext), alert the other store personnel (as early in the
episode as possible) to aid in watching the actions of the
presenter and probable accomplices.

If the police arrive in time to take the person into cus-
tody you can do your part by presenting your facts to the
judge in court.

This article is not meant to bea cure-all, but | believe the onus
for this type of drug problem is on the pharmacist — only he or
she can lower the problem. No one else.

Phillip Paul Weiner, R. Ph.
Baltimore, Md.

CHANGE OF ADDRESS
When you move—

Please inform this office four weeks in advance to avoid unde-
livered issues.

“The Maryland Pharmacist” is not forwarded by the Post Of-
fice when you move.

To insure delivery of ‘The Maryland Pharmacist” and all mail,

kindly notify the office when you plan to move and state the
effective date. APhA members—please include APhA
number.

Nathan |. Gruz, Editor
Maryland Pharmacist

560 West Lombard Street
Baltimore, Maryland 21201

25

PHARMACISTS PLEASE NOTE

CHILD-SAFE CAPS
MAKE VERY [GOOD SENSE,

A

WARE E™

EMPIRIN |
c SOmMPOUND a A

ee PK

: ; ex,
ly iy F gaten Mey
‘te C pe Tlie.

---not necessarily for everyone who needs a fine analgesic like
Empirin® Compound.

That's why the government permits one size with regular cap. For people
who have no children in the house. And for the elderly or handicapped.

For these customers, recommend the 250-tablet, regular-cap bottle of
Empirin Compound. It’s easy to open, economical and profitable.

There's an Empirin Compound for all types of
households, so it’s a good idea to stock and promote | SStv.Sa? Regular

Sizes Cap
all sizes. a me
Empirin Compound —for 50

Burroughs Wellcome Co. 100
Research Tnangle Park
North Carolina 27709

predictable relief of minor pain. ar

et
riitng ts

Use Of Model Bioassays
In Product Development

The use of bioassays to counter rising costs in the develop-
ment of new topical dosage forms is reviewed in the October
issue of the Journal of Pharmaceutical Sciences, published by
the American Pharmaceutical Association.

Because of the average cost of more than $10 million to
introduce a new drug entity, the pharmaceutical formulator
cannot afford to submit suboptimal dosage forms to clinical
investigation. Unnecessary reformulation and repetitive testing
must be avoided.

To reduce this problem, model bioassays have been de-

_ veloped to screen various topical formulations prior to clinical

trials. Pertinent bioassays for various pharmacological classes of
topical agents are discussed and evaluated in this 20-page J.
Pharm. Sci. review.

Antimicrobial bioassays have presented special problems be-
cause of the difficulties in cultivating a model experimental
infection that can be consistently reproduced and that persists
long enough to evaluate formulations for their relative efficacy.
However, several bioassays that satisfy these requirements have
been developed and are grouped under antibacterial formula-

) tions (occlusion test, expanded flora test, and persistence test),
antifungal formulations (experimental Trichophyton mentag-

rophytes infections and in vitro assay in stratum corneum), and
antiyeast formulations.

Two new firsts from District Photo!

Of all bioassays used in the development of topical formula-
tions, those used for topical corticosteroids are the most
sophisticated and refined. The fibroblast assay, the thymus in-
volution bioassay, and the alcoholic vasoconstriction bioassay
have been developed for the evaluation of relative potencies of
the active ingredient. Other bioassays have been developed to
evaluate the relative potencies of finished formulations and to
measure suppression of inflammation and formulation vaso-
constriction. One main advantage of the bioassays of topical
corticosteroids is their correlation with clinical trials.

Model bioassays are also discussed for antimitotics, sun-
screens, antidandruff formulations, anesthetic-analgesics,
antipruritics, antiwart formulations, and products for Rhus
dermatitis and psoriasis.

CORRECTION

APS — THIRD PARTY Rx PLANS: The APS cur-
rent pricing policy listed in the August issue of

The Maryland Pharmacist, p. 21, should be cor-
rected to read: AAC asked, will pay AWP if from
wholesaler and if noted on form.

Turns snapshots into personalized picture postcards and greet- > B |
ing cards. Encourages customers to order extra prints — those S
to mail, those to keep.

PLUS FOTO-DATE Puts the date on the back of each

print, to tell the month and the year it was devel-
oped. A handy record your customers appreciate.

Both at no extra cost to you or your customers!
Both designed to build your photo-finishing profits!

Post Card

Rie Res :

JMterrWvrt

You get both of these tremendous profit-boost-
ing features FREE when you’re a District Photo
Dealer. We’re the company that’s first with the
best new developments in photo-finishing —
Big Shot Borderless Photoprints, Bonus Photo,
Silk-Finish, and One-Day Service.

We believe in firsts, because they keep you first
in sales.

Call us. In D.C., 937-5300. In Baltimore, 792-7740.

DISTRICT PHOTOING

10619 BALTIMORE AVENUE, BELTSVILLE, MARYLAND 20705

OSTCARD & GREETING CARD

Pat pending

POST A PHOTO rersona £ P
N
XQ
RX
re)
XN)

OCTOBER, 1976 27

.

A lot of fine product N

compete for the custom-

ers dollars, at your phar-

macy. So, when it comes time

to stock your shelves, THE &}
MARYLAND NEWS DISTRIBUTING S&F &

COMPANY is well aware of your needs. pil

Our product is periodicals — magazines
and paperback books — and we continually
supply your racks with a variety of current
reading material appealing to every taste and
keeping your Customer reader interest at its
highest.

We understand that turnover is important.
With periodicals you have a sufficient new
product each month to stimulate traffic not
only for our product, but for a// the products
in your store.

An investment of $100 in periodicals,
normally will result in $127 of sales within 30

Oo POE

Pe aie 4a =| Aa =<
By Bi ~ ‘ sg i 4 e SS
Sa m= ee d SN

\
\

Further, since all unsold

copies of our product are return-
able for credit, there is absolutely
—— no risk.
~~ But perhaps the most important fact
is that periodicals have an unselfish way of
helping to sell every other product in your
store. Take a look at the pages of our maga-
zines and see how they showcase just about
every other product that you sell over and
over again. It is like having a built-in
salesman.

To learn how you can really “help your-
shelf,’’ why not give us a call;
The Maryland News Distributing Co.
(301) 233-4545
Ask about periodicals, the unselfish product.

Drug Evaluation (Continued from Page 11)

SUMMARY:

Oxybutynin chloride has been shown to be superior to prop-
antheline in increasing bladder capacity and relieving
symptoms of frequency, urgency, urge incontinence, and pain

' associated with UNB. It is a useful adjunct in the management of
patients with UNB and RNB. Anticholinergic side effects in
' therapeutic doses of 5.0 mg. three times daily probably occur
' with equal frequency but with less severity than with other
_ agents of this class.

- Supplier: Marion Laboratories, Inc.
Forms: 5 mg. tablets
Recommended Doses: adults — 5 mg. 2-3 times daily
(maximum 20 mg. daily); and chil-
dren —5 mg. twice daily (maximum
15 mg. daily).

References

1. Lish, P.M., Labudde, J. A., Peters, E. L. and Robbins, S. |. “Oxybuty-
nin — A Musculotropic Antispasmodic Drug with Moderate An-
ticholinergic Action,” Arch. Int. Pharmacodyn. 156: 467-488, 1965.

2. Fredericks, E. M., Anderson, G. F. and Kreulen, D. L. “A Study of the
Anticholinergic and Antispasmodic Activity of Oxybutynin (Ditro-
pan) on Rabbit Detrusor,”’ Invest. Urol. 12: 317-319, 1975.

3. Ditropan: A Compendium, Pharmaceutical Division, Marion Labs,
Inc., September, 1975.

4. Diokno, A. C. and Lapides, J. “Oxybutynin: A New Drug with
Analgesic and Anticholinergic Properties,” J. Urology. 108: 307-309,
1722

5. Hock, C. W. “Clinical Evaluation of Oxybutynin Chloride,” Curr.
Thera. Res. 9: 437-440, 1967.

Continuing Education (Continued from Page 17)

#376 LECTURE COURSE

Two 3-hour lectures and discussion sessions, one in the Fall
and one in the Spring. To be given at Baltimore, Room 201 —
Allied Health Professions Building.

Subjects: 1. Purpose and Significance of Laboratory Tests
2. Diseases of the Thyroid Gland

Live presentations and discussions
Text: “Applied Therapeutics for Clinical Pharmacists”

Registration Fee: $20.00
Pre-Registration essential
Sunday, January 16, 1977 and May 22, 1977 — 1-4 P.M.

For Information, Contact:

Henry G. Seidman, Director of Continuing Education
University of Maryland School of Pharmacy

636 W. Lombard Street, Baltimore, Maryland 21201
(301) 528-7589, 7118, 7650

OCTOBER, 1976

PIP
# No. 2 %
ofa series

rae

THE AMERICAN PHARMACIST

tO kK Kk kk kk kk
A HERITAGE OF RESPONSIBILITY

THE MARSHALL APOTHECARY

CHRISTOPHER MARSHALL, Irish immigrant,
established his apothecary shop in Philadelphia in
1729. During the next 100 years, this pioneer
pharmaceutical enterprise became a leading re-
tail store, nucleus of large-scale chemical manu-
facturing; a ‘practical’ training school for
pharmacists; an important supply depot dur-
ing the Revolution; and finally, it was managed
by granddaughter Elizabeth, America’s first
woman pharmacist. Christopher earned the title,
"The fighting Quaker,” during the Revolution;
his sons, Charles and Christopher, Jr. (shown as
youths with their father, about 1756), earned in-
dividual fame and carried on his fine traditions.

BARKE DAVIS”
A HERITAGE OF RESPONSIBILITY

© 1954, 1976 Parke, Davis & Company,
Detroit, Michigan 48232

PD-JA-2012-1B-P(11-76)

29

LOEWY DRUG CO. pwision OF AWD, |

Has For Your PHARMACY ZOE
A Complete Price Sticker and °"~
Order Entry Program.

Now Operating in over 500 Pharmacies Like Yours.

THE SERVICE PROVIDES: retail price sticker & shelf labels, allowing you selective
pricing for all items you purchase. Plus customized pricing for up to 1500 items.
Two price system.

OVER THE COUNTER MERCHANDISE RX MERCHANDISE

TAME CR RIN 8 OZ. TAB 20MG NDC 68
#5681 QTY 2 @ $1.25 fea QTY 1. § 0123-61

334. 3s
7312-1359

Electronic Order Entry System

Electronic order entry Terminal for in-store use. It’s. light- Yaa, ¥
weight, portable and enables you to order 200 line items ry |C im
in less than one minute. Transmits over telephone. Opera- CS le ¢
tional 24 hours a day . . . call at your convenience.

Turnover and Profitability Reports samy

Customized series of ongoing Turnover and Profitability
Reports for Your Store. Helpful information compiled from.
product movement of items in your store. _

CHECK THE BIG PLUS FEATURES: REPLY COUPON

LOEWY DRUG CO.

¢ Store Identification Labels. | 6801 QUAD AVENUE, BALTIMORE, MD. 21237
e Complete Product Information. YES, I’d like to get more FACTS ABOUT SPACE:
e Complete OTC and RX Pricing Stickers.

e Quarterly Label Color Change. | NAME

e Tamper-proof (non-transfer) security.

e Ink Screening of Coded Information. | TITLE

e Deal Contents Have Price Stickers.

e Price Stickers for Selected Full Cases. | SAMS

e NDC Numbers on All RX Products. ADDRESS

e Customized Pricing.

e Two Price System. | CITY STATE. ae

| HALT!
| THE BAD CHECK PASSER

Do Not Accept...
1. Money orders in face to face transactions, as they are usu-
ally sent through the mail.
2. “Travelers Checks” not signed in your presence.
3. “Personal Checks” in payment for money orders.

4, Any check if itis not dated, post dated more than 30 days, or
already endorsed.

5. A check with erasure marks, or any change in it.

6. Social Security cards, business cards, club cards, bank
books, work permits, insurance cards, learners permits,
letters, birth certificates, library cards, initialed jewelry,
voters registration cards, etc. UNLESS itis presented with a

current automobile operators license.

7. Any checks marked “hold” or “to hold’. This indicates
subject may just want a loan, rather than a check cashed.

8. Acheck written for a large amount from someone not well
known to you, even though you have cashed several smal-
ler checks for him before.

9. Check passers familiarity with other employees. This proves
nothing with regard to the validity of the check.

Be Cautious Of...

A check drawn on a non-local bank.
A two-party check.
The subject cashing the check. Is he/she the right party?

BRwWnhHP =

. Accepting only one piece of identification. Get two or
more.

5. Accepting a check in which the name of the State does not
agree with the location of the bank.

6. Checks where the company name is ‘‘typed” in. Most
payroll checks are printed.

7. Those who tell you they have cashed checks in your place of
business with other employees before.

8. Anyone who asks that an order be sent to a local address
and then requests the difference in “cash” from the check.

9. Anyone who acts indignant when questioned about a
check.

Dow.

1. Know your endorser. Obtain positive identification of the
passer so as to be able to identify same, if the check is
worthless.

2. Establish a policy for cashing checks and instruct your em-
ployees to use it.

3. Past all “bad check” lists for all of your employees and
customers to see.

4. Notify all employees when a bad check has been received.

5. REMEMBER. . . You donot have to accept any check. This is
your prerogative. Exercise it.

OCTOBER, 1976

oloituariesz

HENRY WICH

Henry Wich, 87, former Associate Professor of chemistry at
the University of Maryland School of Pharmacy, died on August
14. Professor Wich was the last survivor of the School of Phar-
macy Class of 1909. His father, Conrad Wich, founded a phar-
macy at Lawrence and Stricker Streets, which was in existence
for sixty years. Professor Wich is survived by his daughter, Mrs.
Lucille W. Thornton, his son, Dr. J. Carlton Wich, his brother,
Carlton Wich, and six grandchildren. His son and brother are
also pharmacists.

ROSS CAMPBELL

Ross Campbell, a volunteer news correspondent for The
Maryland Pharmacist for many years, died on September 26 at
Union Memorial Hospital after a long illness. In addition to his
work for this journal, he corresponded with several profes-
sional publications, sending them biographical information on
their members. His journalistic work was his hobby and was of
great assistance to The Maryland Pharmaceutical Association
which will greatly miss his dedication and devotion over the
years.

He was aretired Baltimore Gas & Electric Company employee,
but began his hobby long before retirement.

Mr. Campbell is survived by several cousins.

DANIEL E. SMiTH

Daniel E. Smith, owner of Smith Drug Center in Catonsville,
died on Sunday, October 24 following a short illness.

6. Prosecute the writers of bad checks if it’s obvious that their
intentions were dishonest.

7. Keep your bank signature different from your correspon-
dence signature.

8. Limit the authority to “approve” checks to a minimum of
personnel.

9. Photograph everyone cashing checks.

10. Attempt to obtain one fingerprint on back of check.

Conclusion...

Approximately $1,500.00 are taken from businessmen every
minute in the United States. This amount exceeds two million
dollars per day! And, for every five billion checks passed annu-
ally, over ten million are forged. The bad check writer depends
on apathy from businessmen in order to be successful. He
needs this as one of his primary tools. DON’T GIVE IT TO HIM!
Be concerned and see that your employees are.

Source: Baltimore County Police Department

ai

MPhA TRAVEL
BULLETIN

SKI VAIL,
COLORADO

March 5-13, 1977

$359.00 per person
per double occupancy

Special Rates for Children under 12

Trip includes round trip via
United Airlines Charter
8 days and 7 nights
at the HOLIDAY INN.

Limited Space!

Contact Ronald Lubman
(366-1744 or 486-6444)
or
MPhA office (727-0746).

U.S, PO

STAL SERVICE

STATEMENT OF OWNERSHIP, MANAGEMENT AND CIRCULATION

A-200 PYRINATE KILLS'EM DEAD.

Why bother stocking anything else?

is the Pharmacists’ Pediculicide. It’s the
only lice remedy you need to stock. Dis-
play it in the medicated shampoo section
for impulse purchase, and behind the
counter for your own recommendation.

LICE ALERT HOTLINE: When
lice strike, call us toll free at 800-431-1140,
Once the outbreak is verified, we'll
swing into action with a whole program
designed to stop an outbreak before it
gets rolling. And to thank you for your
quick thinking, we'll send
youa gift you can use in
your professional

Crabs, head and body lice, nits — the
only medicine anyone needs to stop them
dead is A-200 Pyrinate, the No. 1 lice
killer. It has the highest turnover rate of
any pediculicide.

At $2.29 suggested retail, A-200
Pryinate means excellent profit for you.
And it’s non-prescription, which means
good walk-in business. It’s advertised in
college and underground papers. And this
year, the Lice Alert Hotline Program will
make people more aware than ever of
A-200 Pyrinate.

Stock both forms of A-200 Pynnate.

The Liquid is ideal for head lice. The Gel practice. 3
is convenient for children, Bs
and for treatment of crab a3
lice in the pubic and , a
hard-to-reach pen-
anal areas. Me
A-200 Pyrinate neg
No. 1
Lice Medicine

—— —— : ,
AVERAGE NO. COPIES EACH ACTUAL NO. COPIES OF SINGLE]

| 10. EXTENT AND NATURE OF CIRCULATION | ISSUE DURING PRECEDING ISSUE PUBLISHED NEAREST TO
_——— =. | i 12 MONTH Sell FILING DATE
; # Be De NIN A. TOTAL NO. COPIES PRINTED (Net Press Run) r “|
= ROT 76 1450 1450
~ Bae eA GAS on B. PAID CIRCULATION | re a
thy ee | Bee 1. SALES THROUGH DEALERS AND CARRIERS, STREET |
) 2 H 10.00 VENDORS AND COUNTER SALES | none none
FPL 1 ATIO pac 7 -
vt ) |
lsisterstown Road. Raleir a 2. MAIL SUBSCRIPTIONS } rare c
town Road, Baltimore | 1355 1254 a
F THE HEADQUARTERS OR GENEF Fe THE Pt ISHERS (Nol | Te.
, < :
vest Lombard Street Jalt * ©. TOTAL PAID CIRCULATION (Sum vf JOB) and 10B2) | 2%c
J “ pore 1?/ 1 4
, £1201 _ pls | 935 1254
R, EDITOR, AND MANAGING EDITOF D. FREE DISTRIBUTION BY MAIL, CARRIER OR OTHER MEANS
=F SAMPLES, COMPLIMENTARY, AND OTHER FREE COFIES 86
ry land iirmace ic. ssociati ly :
sand Pharmaceutical Association, W. Lombard St., Balto.. Md. 21 201 :
cet at ae oy NM. 246 E. TOTAL DISTRIBUTION (Sum of C and D} | 1410
wan I. Gruz, 650 W. Lor 2 D ae ~ : } 1340 3
ruz, 6350 W. Lombard Street, Baltimore, Md. 21201 F. COPIES NOT DISTRIBUTED |
: Soe i z 1. OF FICE USE, LEFT OVER UNACCOUNTED, SPOILED
a : ace wi ; AFTER PRINTING | 40 110 |
an *. Gruz, 650 ¥. Lombard Street, Baltimore, Md. a
ded sc 2 2. RETURNS FROM NEWS AGENTS |
; | none
edia | none
If not« a 3. TOTAL (Sum of EF, F1 and 2—should equal net press run sh : |
; as eas | 1450
; » | SIGNATURE AND TITLE OF EDITO
arcade i. Tcertify that the statements made by me |MANAGER, OR OWNER
E: ; p ADDRESS I - meet 1 let i“ eae &
harmace <>< = - <H ; above are correct and complete c |
ceutical Association 659 W. Lonbart St., Balto., Md. 21201 | CC tia Sh ath
t organization) ILING AT THE REGULAR RATES (Section 192.121, 7
= 4 NING ILDI RCENT ¢ |
,] 4 He 1 T F £ Sha t t
p RT R {EF F 1€ (Uf there " state es
NAN ADORE |
I the ; 1 phased postage
A} T MATE t } 122, PSM) | _ ae eee = --
ot roe a. “heck j | NAGER, OR Te
|
c ~e =
On IN 1 yah ; 223 eT
‘s t nent.)

THE MARYLAND PHARMACIST

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Your patients
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Drug
INlLEPACTIONS s:coso sors

EDI helps you develop competency
as the drug information expert.

Providing current and accurate information on drug interactions, as well as
tables of normal values, the new EDI is extensively indexed by both non-
proprietary and trade names. Published by the American Pharmaceutical
Association, this 576-page book is organized in an easy-to-use format. More-
over, an exacting multidisciplinary review is your assurance of EDI’s accuracy.

@ EDI enables you to function as an informed consultant on drug
interactions. All necessary information is at your fingertips.

Since you are the one who stands between your patients and serious drug interactions,
> you must have information that is as practical as it is reliable. EDI affords the easiest way
to locate that information — and the clear and comprehensive recommendations to give
both your patients and prescribers.

a EDI can help you eliminate preventable adverse drug
incidents and assure the health and safety of your patients.

@ EDI helps you protect your patient’s health— it could even help you save a
life. The new EDI provides you with a professional “instant recall button”
you can push any time you suspect the health of your patient is threatened by
a drug interaction. Adverse drug incidents often mean additional care; EDI
helps you save your patients this added burden, inconvenience, and cost.

EDI helps you demonstrate and use what you know
about drugs and drug therapy.

This dynamic clinical tool is a handy reference source that you will use every
day to safeguard the health of your patients.

Put your professional knowledge to work with the new EDI!
American Pharmaceutical Association 2215 Constitution Avenue N.W., Washington, DC 20037

Order Desk:
ORDER American Pharmaceutical Association EVALUATIONS OF DRUG INTERACTIONS |

FOR \ i 2215 Constitution Avenue N.W., Washington, DC 20037 Second Edition

Price: p 7

APhA members $875 Non members $12.50

* Spedal Introductory kate for APhA members APhA
NAME Good thru December 31, 1976 MEMBERS:

(To receive favored member rate, mailing label from JAPAA or a label

APhA Weekly must be attached to this order. ) rina 23
ADDRESS JAPhA

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@ $12.50 (Non members)

CITY

| Total remittance enclosed $ _) Billme

Orders for less than $20.00 must be prepaid.

STATE ZIP - : : 3
For quantity discount schedule (10 or more copies),
Prices include shipping or mailing at lowest cost surface rate. Allow four weeks for delivery. ) write to Publications Division.

Messages — Then and Now:
1961 and 1976 :
An Editorial

Proceedings of the Fall Regional and
House of Delegates Meeting

Professional Continuing Education Program
MPhA-MSHP JOINT MEETING

Towson Plaza — Garden Room
Thursday, January 13, 1976

THE MARYLAND PHARMACIST

650 WEST LOMBARD STREET
BALTIMORE MARYLAND 21201
TELEPHONE 301/727-0746

NOVEMBER 1976 VOL. 52 NO. m

CONTENTS

Editorial
6 Messages — Then and Now: 1961 and 1976
— Nathan I. Gruz

Articles
Membership Committee Plans Active Campaign

Proceedings — MPhA Fall Regional and House of Delegates
Meeting

12 The Colonial and Revolutionary Heritage of Pharmacy in
America — The Colonial Practice of Pharmacy: Part II
— David L. Cowen
16 Fall Regional Meeting Photo Coverage

Departments
Calendar

15 Drug Evaluation — Nitroglycerin Ointment Revisited
— Ralph F. Shangraw

26 News

29° Open Forum

29 Obituaries

30) MPHA Travel Bulletin — Convention

ADVERTISERS
20 Abbott Laboratories 11. Mayer & Steinberg, Inc.
14, 25 Burroughs Wellcome 30 Norcliff Thayer
17 Calvert Drug Company 28 Paramount Photo Service
26 District Photo Inc. 18-19 Pharmaceutical Manufacturers’
4-5 Geigy Pharmaceuticals Association
3 Eli Lilly & Company, Inc. 22 Smith Kline & French Laboratories

32 Loewy Drug Company

31 Maryland News
Distributing Company

Seeman
Seinen adaniiaianataneere aera SS eS et Ceara tretceaismnaiimninnaaucnemeaene oes

Change of address may be made by sending old address (as it appears on your journal) and new address
with zip code number. Allow four weeks for changeover. APhA members — please include APhA number.

The Maryland Pharmacist is published monthly, except for January, February, and March, 1976, combined,
by the Maryland Pharmaceutical Association, 650 West Lombard Street, Baltimore, Maryland 21201. Annual
Subscription — United States and foreign, $10 a year; single copies, $1.00. Members of the Maryland
Pharmaceutical Association receive The Maryland Pharmacist each month as part of their annual member-

ship dues. Entered as second class matter December 10, 1925, at the Post Office at Baltimore, Maryland,
under the Act of March 8, 1879.

NATHAN |. GRUZ, Editor
RICHARD M., SCHULZ, Assistant Editor
ABRIAN BLOOM, Photographer

OFFICERS & BOARD OF TRUSTEES
1976-77

Honorary President

MORRIS LINDENBAUM

President

MELVIN N. RUBIN—Baltimore

Vice President

STANLEY J. YAFFE—Odenton
Treasurer

ANTHONY G. PADUSSIS—Timonium

Executive Director
NATHAN |. GRUZ—Baltimore

TRUSTEES

HENRY G. SEIDMAN, Chairman
Baltimore

LEONARD J. DeMINO (1978)
Wheaton

S. BEN FRIEDMAN (1979)
Potomac

RONALD A. LUBMAN (1979)
Baltimore

ROBERT J. MARTIN (1977)
LaVale

JERRY OVERBECK (1978)
Salisbury

VINCENT DE PAUL BURKHART (1977)
Baltimore

EX-OFFICIO MEMBERS
WILLIAM J. KINNARD, JR.—Baltimore
ROBERT E. SNYDER—Baltimore

HOUSE OF DELEGATES

Speaker

VICTOR H. MORGENROTH, JR.—Ellicott
City

Vice Speaker

SAMUEL LICHTER—Randallstown

Secretary

NATHAN I. GRUZ—Baltimore

MARYLAND BOARD OF PHARMACY
Honorary President

FRANK BLOCK—Baltimore

President

1. EARL KERPELMAN—Salisbury

ESTELLE G. COHEN—Baltimore
LEONARD J. DeMINO—Wheaton
BERNARD B. LACHMAN—Pikesville
RALPH T. QUARLES, SR.—Baltimore
CHARLES H. TREGOE—Parkton
Secreta

ROBERT E. SNYDER—Baltimore

THE MARYLAND PHARMACIST

:

The one the patient takes
is never tested.

Surprising, perhaps, butit makes sense
when you think about it.

Obviously, the actual dose of any pre-
scription drug the patient takes cannot be
tested because it would have to be broken
down for analysis—after which it could
never be used by a patient.

This means that you depend on the
manufacturer for assurance that the dose
the patient takes is identical to the ones
which have been tested.

At each step in the manufacture of a
Lilly drug, test after test confirms the in-
eredients, formulation, purity, and
accuracy —all the critical factors that as-
sure that every Lilly medicine is just what
the doctor ordered.

Thats particularly important, as you
know. The same drug made by different
companies can be chemically identical
yet may act differently in the human body
because of the many variables in the way
the drugs are manufactured.

And, of course, government standards
alone do not assure the efficacy and con-
sistency—the quality of each drug you
dispense.

As we at Eli Lilly and Company see it,
the ultimate responsibility for quality is
ours.

For four generations weve been mak-
ing medicinesas if peoples lives depended
on them.

600090

Lilly

ELI LILLY AND COMPANY, INDIANAPOLIS, INDIANA 46206

November 1976 marks the completion of fifteen years as the
Executive Director of the Maryland and Baltimore Metropolitan
Pharmaceutical Associations and Editor of The Maryland Phar-
macist. It is an appropriate time to look at some thoughts ex-
pressed in 1961 in the new editor's first editorial:

PRACTICE OF PHARMACY UNDER ASSAULT

There is no question that the practice of pharmacy as we
have known it is under massive all-out assault. The atom-
bombs of supermarket invasion of health and beauty needs
traditionally in the realm of pharmacy has been progressing
rapidly for some time. Then the hydrogen-bombs of mail-
order prescription plans descended. Today we are subjected
to the hundred megaton bombs of discount prescription
operations.

Now all the fruits of neglect of the basic facts of phar-
maceutical life are being harvested.

No one for sure can give all the answers. But as immediate
first aid measures in these critical times in both the profes-
sional and economic life of pharmacy we must concern our-
selves with what we can do alone as individuals and what we
can do together as a group united against a common threat.

Individually, each pharmacist must strive more than ever
to enhance his personal professional image and the profes-
sional image of his own pharmacy. He must extend himself to
give personal service to his clientele—to demonstrate that
the community pharmacy is the ideal source for pharmaceu-
tical services, health and beauty needs; and that the com-
munity pharmacist is the expert best qualified to counsel
about drugs and vitamins.

Collectively, we can join together in support of local, state
and national pharmaceutical organizations that are working
to properly represent pharmacists and to fight for the best
interests of both the public health and the profession of
pharmacy.

Pharmacy has been losing its battles because its forces
have been thin — emaciated by lack of 100% support —
dragged down by free-loaders, who do not carry their share
of the burden — weakened by those who wish to receive
without being willing to contribute and to sacrifice for both
their own and the common good.

editorial

MESSAGES — THEN AND NOW:
1961 and 1976

Now — or never — is the time for pharmacists to unite and
to provide 100% membership to their associations and 100%
support for funds established to work for their benefit. Only
through the sacrifice of men willing to devote their time,
energies and the necessary finances, will pharmacy have the
resources to provide the organizational strength for suffi-
cient funds and qualified personnel to plan, to work, to fight
and win the battles for professional and economic survival.

—The Maryland Pharmacist, Vol 37, pg. 268, (November 1961)

In the same issue the following message was published:

In this first message as your new Executive Secretary and
Editor of The Maryland Pharmacist, | would like first to ex-
press my appreciation of the honor and privilege bestowed
upon me. The Maryland Pharmaceutical Association has a
long and honored place in the history of American phar-
macy. These offices have been held by such incomparable
giants as E. F. Kelly and Robert L. Swain, who starting from
within our own precincts attained the pinnacles of recogni-
tion in the world of pharmacy. All my predecessors who have
held these positions have left a legacy of high standards of
accomplishment, which a newcomer can approach only with
respect, humility and the resolve to emulate.

Second, the membership is entitled to know the
philosophy which will motivate their Executive Secretary. In
brief, my approach to the profession of pharmacy and to the
position which | am now honored to hold is:

Pharmacy is an honorable profession devoted primarily to
making readily available the most effective medication for
all humanity and thereby deserving an undisputed posi-
tion as an integral member of the modern medical care
team. The Maryland Pharmaceutical Association is the
professional society of all pharmacists in the State of
Maryland. Only through the voluntary banding together
of all pharmacists, as well as those allied with the profes-
sion, can both the interests of public health and the re-
quirements of a noble calling be welded together. Only
through united organizational efforts can pharmacy
secure its rightful position as a profession performing an
indispensable service in an economy in which changes
are occurring at a revolutionary rather than at an evolutio-
nary pace.

THE MARYLAND PHARMACIST

|

A

As the executive officer of the Association, my resolve is
to mobilize the resources of all segments of pharmacy —
retail, wholesale, manufacturing, hospital, academic,

law-enforcement, and any other — in order to advance

the interests of pharmacy as a profession and to
| strengthen its economic foundations against increasing
; assaults.

. In order to progress we must have new ideas, and | there-
) fore openly invite you to participate, to make suggestions
and constructive criticism for the mutual good of all.
The office of the Association will at all times strive to
provide within its capabilities the services and assistance
| which the membership requires.

At this time the practice of pharmacy in the United States as
a profession is in the most critical stage of its history. Its
future — its fate — is being decided right now by the nature
of our actions, as individual pharmacists and by the quality of
leadership our pharmaceutical organizations can provide.

If there are honest differences among us, they can surely
be resolved in a spirit of mutual goodwill. The ties of com-
mon self interest that unite all of us in the world of pharmacy
far out-weigh the minor, sometimes trivial differences,
which sometimes have become magnified out of proportion
and have given comfort to the enemies of pharmacy.

| look forward to working together with all of you ina spirit
of cooperation, understanding and goodwill.

There have been many changes during the interval since
| assumed office, but this outlook still represents my philosophy
and convictions. That is at least one satisfaction that can be
derived in contemplating the never ending and constantly pro-
liferating problems facing one involved in pharmaceutical asso-
ciation management.

To cope with the constantly accelerating pace of change and
to be prepared at all times for “future shock,”’ one must look at
these developments not as “problems,” but as challenges.

So in looking ahead, the ideas expressed fifteen years ago are
still a foundation — a bedrock of personal commitment. With
the participation of constructively motivated colleagues, we can
expect to move step by step to the fulfillment of realistic goals.
Let us all be thankful for the contributions of those members
who work to advance the profession by service to their profes-
sional societies with devotion, intelligence, farsightedness and
loyalty.

For one laborer in the vineyard, this is also an opportunity to
give deeply felt thanks for experiencing what is truly meaningful
and worthwhile in life. So appreciation goes out to those who
have and do make a difference in the lives they touch upon:
fellow members who are perceptive, straightforward, unselfish
and supportive; loyal, dedicated staff; professional colleagues
in and out of pharmacy, both here and through the nation, who
always gladly respond when called upon; and above all the
understanding, patience and love of one’s wife, family and
friends.

As the season of good will permeates the land, let true and
lasting peace prevail at home and abroad; and let the serenity of
inner peace enable us to proceed with our appointed tasks for
significant personal fulfillment through compassionate service
to others. — Nathan I. Gruz

NOVEMBER, 1976

Membership Committee
Plans Active Campaign

The MPhA Membership Committee, chaired by Elwin Alpern,
met on October 26 to develop a plan for increasing the mem-
bership of MPhA and affiliated local organizations. Stemming
from this meeting, the following action items are to be under-
taken:

1) Conduct a general mailing to non-members listing the
benefits of membership, recent actions of MPhA, and an
opportunity for non-members to list areas of disgruntle-
ment with the association.

No

In conjunction with Prince Georges-Montgomery County
Pharmaceutical Meeting of November 23, MPhA is to field
questions from the invited audience of member and
non-member pharmacists from that local society.

W

Undertake a massive membership campaign utilizing local
organization contacts. Plans are to have non-members of
each area invited to local meetings with MPhA officers
present who will cite advantages of membership and will
answer questions from those gathered.

oS

Enlist the assistance of recognized ‘‘leaders”’ in past
graduating classes to spread the benefits of membership
to pharmacy classmates.

ea)

Conduct an incentive program granting rebates to af-
filiated local associations for new members brought into
the organization.

6) Coordinate the membership drive with APhA efforts.

Ealencdex

January 15-22 — MPhA Seminar and Tour —
Acapulco

February 13 (Sunday) — Baltimore Metropolitan
Pharmaceutical Association Annual Banquet

and Dance, Bluecrest North

March 5-13 — MPhA trip to Vail, Colorado.

March 17 (Thursday) — MPhA Swain Seminar
March 28 (Sunday) — NARD National Legislative and
Public Affairs Conference, Washington, D.C.

April 21 (Thursday) — MPhA Spring Regional and
House of Delegates Meeting, Friendship Inter-
national Hotel.

May 15-19 — APhA Convention, New York City
June 17-19 — MSHP Annual Convention — Sheraton
Hotel, Ocean City, Maryland

June 19-22 — MPhA Annual Convention — Carousel
Hotel, Ocean City, Maryland

PROCEEDINGS

Maryland Pharmaceutical Association

FALL REGIONAL & HOUSE OF DELEGATES MEETING
October 14, 1976 — Ramada Inn, Beltway

The Fall Regional Meeting was called to order by President
Melvin N. Rubin at 9:15 A.M.

The President called upon affiliated and recognized organiza-
tions for a report or message. The following responded: Balti-
more Metropolitan Pharmaceutical Association — Ronald
Lubman, President; Prince Georges-Mongomery County
Pharmaceutical Association — Paul Reznek, Secretary; Eastern
Shore Pharmaceutical Society — Samuel Morris, Secretary; Anne
Arundel County Pharmaceutical Association — Vincent Re-
gimenti, Vice President; Maryland Society of Hospital Pharma-
cists — Mary Connelly, past President; George Stevenson,
Chairman of the MPhA Industrial Relations Committee on be-
half of the industry representatives in attendance.

PRESIDENT’S REPORT
The following report was distributed to the delegates.

The first part of my term in office has been spent to a large
degree in organization of the year’s activities. | want to thank
the committee chairmen who jumped right in and went to work.
George Stevenson and Vic Morgenroth started early in the
summer, and others from whom you will hear today have begun
their year’s programs. | especially want to call attention to the
effort given by Marv Friedman and others on Medicaid prob-
lems, which seem to increase in complexity and quantity as the
programs grow.

Despite divided sentiments, | feel that the Association’s
course in handling the MAC/EAC problem was somewhere be-
tween the right way to go and the only way to go. We have every
reason to believe that we will achieve as much or more parity
without having to resort to a court of law than if we had. | realize
that many members felt that this was the place to draw the line
and fight Medicaid — win or lose; but | am glad that many finally
decided that we should temper our feelings with reason.

| feel that Dick Parker’s Legislative Committee has come up
with a program that not only guides us on a good professional
course, but takes advantage of all the resources at our disposal.
We should be much more effective in Annapolis with fewer
disruptions to the rest of the Association business by working
with the other pharmacy groups in the state as well as consumer
groups to attain our objectives. To this end, the Consumer
Atfairs Committee chaired by Paul Freiman will be a great asset
in helping meet our legislative goals.

| am glad that | was able to attend functions of the Eastern
Shore, Allegany-Garrett, Baltimore Metropolitan and Anne
Arundel Pharmaceutical Associations and look forward to visits
to the other groups at least once during the year. The responses
and hospitality have been very warm.

| want to thank the office staff for the efforts they have given
to the volume of minutes, notes, drafts and correspondence
that | and the committee heads have thrust on them. From the

8

point a few years ago when communications within the Associa-
tion were held back due to work loads seemingly too large to
handle, the staff has shown a willingness and ability to transmit
information to members that would have seemed impossible.

Also of note is the fact that The Maryland Pharmacist is almost
up to schedule and we will now be able to devote more atten-
tion to increasing the advertising revenue generated by the
publication. The Association’s finances have been aided in the
past few years by successful trips run by Ron Lubman, but with
changes in regulations for charter flights, we can expect to have
less support from non-members and hope to make up the
difference from the The Maryland Pharmacist as well as added
membership.

In keeping with my desire to have as much time as possible at
the regional devoted to business at hand and to give as many
members as possible the chance to speak, | will restrict my
formal remarks to items which have come up since this report _
was written.

President Rubin delivered the following President’s message
at the meeting.

| welcome you to the MPhA Fall Regional and House of Dele-
gates Meeting, with a special greeting to the drug manufacturer
representatives who are here today.

The interest shown as a result of the work of the Industrial
Relations Committee is evidence that the manufacturers recog-
nize the need to improve relations with pharmacists. | hope
they will see by the programs we are working on that our
interests are providing the public with the professional services
for which we are trained and which the public has a right to
expect.

Our legislative program will include continued work promot-
ing the pharmacist’s ability to select a brand of drug once the
physician has chosen the drug entity. | do not expect my com-
ments will be taken too critically because it appears that major
manufacturers now realize they must provide the patient with
less expensive products once the patent rights on a drug prod-
uct have expired. Some of the largest companies are promoting
and distributing generics or branded generics, and they are
using generic houses to supply many of the products at lower
costs.

While we work for product selection we hope that manufac-
turers will keep in mind that the way to join the tide of the future
is to show us clearly that they produce quality products at
appropriate prices. This means making available all bioavailabil-
ity, proof of efficacy, and other data for us to examine. This also
means they should not hold onto every dollar of profit a drug
can make once research expenses have been met.

Work with us and APhA to take the mystique out of drug
prescribing. Realize that the patient needs a break and, frankly,

THE MARYLAND PHARMACIST

so do we. Sufficient funds for payment of drugs under third
party programs must be left over to provide pharmacies a fair
profit. Our presence is necessary for benefits to reach the
patient.

Plain talk — no “campaign rhetoric’ — is what our Industrial
Relations Committee will have to work with. There is enough
common ground and we hope to explore all of it in due time.
Initial committee projects are perhaps less controversial,
primarily establishing work relationships.

| am disturbed by a handful of pharmacists who remind me of
the pharmacy owners of 25 years ago — unable to see the future
because their profits blind them. | emphasize that only a few
owners are still this parochial. How viable and profitable phar-
macy will become depends on us today. We must continue our
education; we must offer patient profiles and all the services
that they open for the patient; we must work for the right to
dispense quality medication the patient can afford; we must
work for more avenues for the pharmacist to use his training.
Those few who do not want to work in these directions because
they see no immediate dollar signs will be talked about in 10 or
20 years as those responsible for the end of the independent

pharmacy. ‘Count and pour” doesn’t cut it anymore — anyone
can do that.

MPhA spends a lot of time working for the owner — and we
should. But the emphasis must be on the pharmacist, wherever

he works. Otherwise the non-pharmacist owners will exercise

too much control. Certainly we want equitable reimbursement

from third parties. Certainly we must keep a place for the inde-

_ pendent pharmacy. Without ownership as an alternate to being

employed by others, all pharmacists will be in the same situa-
tion as nurses — highly trained, highly respected, yet under-
paid. But the only effective way to progress is by striving to
identify and maintain proper standards and areas of practice.
Either we make more visible our qualifications and abilities to
give proper health care, or we will not be able to stop the
erosion of those looking for price alone to non-pharmacy
oriented outlets, orto HMO’s for those seeking the level of care
we should be providing.

| feel it is necessary to continue to press for mandatory con-
tinuing education so all pharmacists will perpetually remain
qualified to provide needed services. | am tired of hearing from
doctors and legislators, ‘It would be OK if all pharmacists were
as interested and knowledgeable as you. . . .”” Most of you fall
in that category, and | can assure the rest that even those of us
who were C students in school learn from continuing education
lectures without trying very hard — when the courses are rela-
tive to our functions.

However, | personally disagree with existing policy to work
for mandatory profiles. There is no dispute that every pharmacy
should keep them. All excuses are lame. But again, drawing
from my own experiences, the pharmacist must have the inter-
est and desire to utilize profiles. After a couple of years of
appropriate continuing education, he or she will.

President Rubin then reported the recommendation of the
Board of Trustees for the approval of Nathan I. Gruz as interim
Executive Director.

President Rubin called upon Executive Director Nathan Gruz
for his report.

NOVEMBER, 1976

EXECUTIVE DIRECTOR’S REPORT

The period since the last House of Delegates meeting at the
Convention in June has been a particularly full one for the
officers, the Board, the Association and very much for the entire
staff. My staff — Carol Yarsky, Joan Hurlock, Mary Ann Frank
and Richard Schulz — deserves much credit for extending
themselves in producing a tremendous amount of printed
material. The reports and volume of paper distributed during
the past 3 months and at this meeting attest to that.

| think it is imperative that the Board of Trustees and all
delegates pause and assess the situation.

@ What are the Association’s objectives? Are they realistic?

@ What are the Association’s priorities? Do they meet phar-
macy’s and the public’s interests?

® What are the strategies that must be developed to achieve
these objectives and priorities?

In light of present resources both financially and in staff
personnel, what can we realistically conclude about these three
critical factors?

The Regional Meetings and committee activities have been
established to achieve certain goals. What are these goals? Has
MPhA created a situation of ‘“means” overpowering its “ends”
— are “means” killing ‘““ends’’? Can we operate effectively
when, before digesting and adequately implementing the re-
sults of an Annual Convention, we must prepare for a Regional
‘‘Mini-Convention.” (I have heard our president ina slip of the
tongue repeatedly refer to this Regional as ‘‘Convention.”’)

Organizations much larger than MPhA, like the state Medical
Society with a staff many times the size of MPhA, conduct their
business at their Annual House of Delegates Meetings with
resolutions being submitted not less than 60 days prior to the
meeting. At their semi-annual meeting, there is a limited
agenda, primarily continuing education.

Aren’t our members primarily interested in issues: continu-
ing education, professional and economic status and advance-
ment, establishment of Standards of Practice, participation in
health planning, rather than organizational matters? The best
attended programs in pharmacy are those that help the pharma-
cist be more effective in his professional responsibilities which
enable him to grow as a pharmacist and as a person.

Now as to issues:

® Third party Rx programs (both government and non-
government) with the associated problems of HMO’s,
health centers, group practice and national health insur-
ance provisions pertaining to pharmacy — these must be of
primary concern.

@ The role of the employed pharmacist and his legitimate
aspirations for professional and economic security are of
critical importance.

® The initiatives of legislators and consumer groups in regu-
lation of health professions will continue to be a challenge
to pharmacists and their professional societies.

MPhA’s immediate imperative must be expansion of the
membership base and its resulting revenue generation to
represent pharmacy more effectively and to fund the
priorities agreed upon so that appropriate strategies can be
implemented. The Membership and Finance Committees

9

have already begun to look at some new approaches. Suc-
cess will depend upon a broad participation in their pro-
grams.

Together with PHARMPAC — MPhA’s political action arm —
preparations must be accelerated for the forthcoming legisla-
tive session. The Tripartite Committee and the Board of Phar-
macy must accelerate the development of guidelines and regu-
lations. Necessary funding of the Board must be received. This
won't be easy, we know.

The local associations will need more active attention from
MPhA in order to involve more pharmacists and thus enable
these pharmacists to contribute to the development of policy
and guidelines.

We must demonstrate concern and sensitivity for tradition by
assuring appropriate Commemoration of milestones in our
Association history. MPhA is 94 years old and we must begin
now to plan our centennial. The Kelly Memorial Building, com-
pleted in 1952, will mark the 25th anniversary of its dedication in
January 1978.

As to internal association problems, men and women of good
will, with realistic, balanced perspectives can overcome many
of the obstacles besetting us within our organization. | wish to
thank all those who have worked in a constructive manner to
further pharmacy, MPhA and me personally to work and fight
for pharmacy.

Now, if | may, a short personal note. | have devoted almost
half my adult life to MPhA, first as an assistant and then as
Executive Director for the past 15 years. | have been dedicated
to the preservation of pharmacy as a free, independent pro-
fession; to enhancing its status; to raising its standards of prac-
tice and its esteem in the public mind; | have fought as its
advocate before any and all individuals, officials, agencies or
organizations. And | aim to continue this dedication in the
service of MPhA and of pharmacy as long as | am given the
opportunity.

President Rubin then called upon Speaker of the House of
Delegates Victor H. Morgenroth, who called the meeting of the
House of Delegates to order at 9:45 A.M. He called upon the
Secretary of the House Nathan Gruz who reported a quorum of
delegates in attendance. The minutes of the previous meeting
of the House of Delegates at the Annual Meeting, June 21-22,
1976, were approved upon the motion of S. Ben Friedman, duly
seconded and passed.

REPORTS:

1. Treasurer Anthony G. Padussis presented the statement of
cash receipts and disbursements through September 30. A
motion for adoption was seconded and passed.

2. Membership Committee Report — Elwin Alpern, Chairman.
A program for a membership campaign for the 1976 associa-
tion year is being prepared. Plans are being made for a
Membership Committee meeting to launch a drive. The
agenda includes preparation of lists of non-members by
graduation class date from the University of Maryland
School of Pharmacy. An attempt will be made to assign
solicitations of non-members by members of the same class
if at all possible. We will seek at least two members from
each class to make contacts of non-members where we can.

10

The presidents and membership committee chairmen of —

local affiliates and MSHP will be invited.

The paid up membership figures as of September 30 are 771
plus 151 SAPhA-MPhA members or 922 compared to 726
plus 76 or 802 last year same time. The total paid up mem-
bership for 1975 was 755 plus 80 students for a total of 835.

The report was adopted.

. Legislative Committee Report — Richard D. Parker, Chair-

man. The Legislative Committee met on August 4, 1976, to
review the policies of MPhA concerning expected or de-
sired legislation for the coming year. No major problems
are currently on the scene, but we will be placing full em-
phasis on Drug Product Selection as a professional preroga-
tive of the pharmacist. The consumer action group,
MaryPirg is expected to be supportive of our position and
we look to that group to lead the battle for us. Delegate
Torrey Brown will most likely introduce a bill, but other
support from the House of Delegates and the Senate is
probable.

The committee studied our position on Patient Medication
Profiles and Continuing Education and reaffirmed the deci-
sion that regulation by the Board of Pharmacy should re-
quire these as Standards of Practice. We also endorsed the
principle of a court test on the constitutionality of Manda-
tory Price Posting by supporting the request for declaratory
judgement being sought through Legal Counsel, Joseph
Kaufman. We favor the principle of disciplinary powers
being defined so that the Board of Pharmacy may reprimand
pharmacists for criminal acts outside the scope of Pharmacy
laws. Member Paul Cuzmanes is working with the Tripartite
Committee on a new draft of Pharmacy law which will cor-
rect several existing deficiencies. Paul hopes to have a draft
available this fall for review. Members Michael Roberts and
Paul Freiman are reviewing the APhA Policy Manual to pre-
sent to the Spring Regional meeting a recommendation for
MPhA policy position.

The Legislative Committee asks the House of Delegates to
voice support for the continuation of the above decisions
and to present to it any recommendations for action.

Mr. Parker moved for the adoption of the report with an
amendment to indicate elimination of the approval of pro-
files as a mandatory regulation. Seconded and passed. Vin-
cent Gattone, Eastern Shore delegate, recommended
MPhA makes a standard profile card available for use by
members.

. Finance Committee Report — Stanley J. Yaffe, Chairman.

Since the convention, the Finance Committee has held two
meetings to review the financial condition of the Associa-
tion, the income and expenditures of the current year,
anticipated income for the next year and began work on the
budget for 1977.

One committee meeting was with the Association’s Cer-
tified Public Accountant at which time it was recommended
that changes be made in bookkeeping procedures and re-
porting and that a double entry system be installed, which
will begin Jan. 1. The Committee is working on a program to

(Continued on Page 21)

THE MARYLAND PHARMACIST

)

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The Colonial and Revolutionary Heritage

of Pharmacy in America

by David L. Cowen*

The Colonial Practice of Pharmacy — Part Il

THE DRUGGIST

The term ‘druggist’ was originally applied to the wholesaler
of drugs and there is some indication that there were such
dealers of drugs in Boston as early as 1690. The druggist needed
no special medical or pharmaceutical background but it is in-
teresting that the druggists either claimed such a background or
soon assumed that they were competent to practice pharmacy.

Perhaps the most famous of the druggists were Drs. Daniel
and Joshua Lathrop of Norwich, Connecticut. Both practiced
medicine and Daniel was said to have learned the art and mys-
tery of the apothecary in London. Their “huge gardens and
greenhouses” for the growing of medicinal plants have already
been mentioned in this series; in addition, the Lathrops were
astonishingly large importers of drugs. It is no wonder that the
Lathrop family were noted for their philanthropies.

In New Jersey the physicians John Griffith and Moses Scott
continued to practice medicine and surgery when they opened
a druggist’s business in New Brunswick in 1774. Their accounts
show that they did a flourishing business with their medical
colleagues who did not seem to mind that members of the
profession had gone into business. In Charleston, South
Carolina, Joseph Chouler, ‘‘Apothecary, Druggist, etc.’’ adver-
tised huge quantities of drugs for sale in 1797.

But there were other druggists who made no claim to a medi-
cal or pharmaceutical qualification. In New York, Smith, Moore
& Co., “At the Medical Pillar’ advertised, in 1784, a “General
Collection of Materia Medica, Botanical, Chemical, Galenical,”’
and a full line of patent and proprietary medicines and physi-
cian’s and apothecary’s supplies. Their amusing advertisement,
in verse, was directed to the medical practitioner whom they
promised an “active scale and ample measure.”

Finally there was Benedict Arnold, hero and villian of the
American Revolution. Arnold, “a half-bred apothecary” — he
had served a partial apprenticeship under the Lathrops — adver-
tised himself as “Druggist, Bookseller, &c from London” in New
Haven in 1761. But Arnold’s concern with books and the wide
variety of sundries he carried (see the illustration) suggest that

“David L. Cowen is Professor of History at Rutgers, the State University
of New Jersey.

Reprinted with permission of the author and The New Jersey Journal of
Pharmacy.

12

despite the title ‘‘druggist’’ Arnold really ran a retail establish-
ment. His biographer says that he was soon relishing being
called ‘Dr. Arnold’ by his clients.

The druggist did not restrict himself to medicines and medical
supplies. The Smith, Moore & Co., advertisement, which was
typical, also advertised confections, groceries, chemicals,
leather, tin-foil, oilcloth and perfumes, among other sundries.
Arnold’s stock, besides prints and books, included painter’s
colors, a “few very neat watches,” necklaces, earrings and
buckles and buttons.

Druggists were occasionally prepared to fill prescriptions, but
when they did so they were moving out of the wholesale busi-
ness and into the practice of pharmacy.

THE MERCHANT

The merchant who dealt in drugs and made no pretension at
having a medical or pharmaceutical training was frequently
encountered throughout the colonial period and into the
nineteenth century. (Indeed today’s supermarket is a reversion
to older times in this respect.) The merchant, or general
storekeeper, handled crude drugs (like rhubarb, Jesuit’s bark,
jalap and opium), patent and proprietary medicines (like Fran-
cis’ Female Elixir, Bateman’s Cordial Elixir, Anderson’s Pills and
James’ Fever Powder). They sometimes handled prepared
medicines as well, like mercurial preparations, tartar emetic,
extracts and essences. Their clientele was largely given to self-
diagnosis and self-medication — professional services of the
physician, even if available, were something of a last resort.

Like the druggist, the merchant who handled drugs carried a
wide line of other merchandise. Indeed drugs were often only
one part of the general store that also carried, as did the shop of
Mary and Sarah Barnes of Trenton in 1781, for example, printed
silks, gauze, China, thread, needles, orris, and brass carriage
furniture. Other stores, more commonly, carried groceries,
paints, dyes, ironmongery and dry goods.

Two famous Americans became storekeepers who dealt in
drugs. One was Button Gwinnett of Georgia, the signer of the
Declaration of Independence whose signature is now so rare.
The other was none other than Benjamin Franklin. Franklin
opened a store in Philadelphia where he offered a variety of
commodities from ‘‘needles and pins to horses and slaves.” His

' THE MARYLAND PHARMACIST

1

medicines included ‘Seneca rattlesnake root with directions
how to use it in pleurisy.”’ It is difficult to imagine a man of
Franklin’s personality not diagnosing and prescribing over the
counter.

THE PHARMACIST

The lines of demarcation between the physician, the
apothecary, the druggist and the merchant are not easily put
down. They all practiced pharmacy, they all seemed to move
freely from one category into another, and they all used what-
ever appellation suited their purposes. In addition to this group,
however, there seem to have been some who considered them-
selves mainly what would today be called “pharmacists.” They
called themselves apothecaries, or, sometimes, chemists, and
later, when the term lost its wholesale connotations, druggists,
but they were involved mainly with the compounding and dis-
pensing of medicines.

Some emerged from the wholesale druggists and for a while
the “wholesale and retail druggist’ was common (and accounts
for the later popularity of the term ‘druggist’ for what is now
called the ‘‘pharmacist’’). There are instances where merchants,
whose stock-in-trade was largely medicinal, considered them-
selves practitioners of pharmacy. There were also physicians
and apothecaries who virtually left the medical profession to
concentrate on pharmacy. Often physicians and apothecaries
sold their shops to apprentices as they moved into a purer
medical practice. There were too, it must be added, those who
without a suggestion of qualification, practiced pharmacy by
instinct.

In any case there is ample evidence that in the eighteenth
century there were what we would today think of as drugstores.
In Boston William Rand “At the Sign of the Unicorn” (1733), in
New York G. Duyckinck ‘‘At the sign of the Looking Glass and
Druggist Pot’’ (1769), in Savannah G. Harral at his ‘New
Medicine Store” (1797) were operating what were essentially
drugstores. In Philadelphia Christopher Marshall established
something of a pharmaceutical dynasty when he opened a shop
m1729,

Such drugstores also found it necessary to carry a wide line of
merchandise, sometimes related to pharmacy, sometimes unre-
lated. The need for the pharmacist to augment his income by
carrying non-medical items has a long tradition in the United
States as well as elsewhere.

NOVEMBER, 1976

Benedia@t Arnold,

Flas sufi imported (via New-York) and fells

at his Store in New-Haven,

A very large and frefh Affortment

of DRUGS and CuyMicAL PREPARATIONS ;

SSSENCE Water
Dock
Effesce Balm Gilead
Birgamos
Lemoas
TinGure of Valerisa
Pe&toral BalfamHoney
Batemas’s PeAoral
Drops
Bridthh Ou
od "mSordial
urliogton’s Balfam
Lit

Bales Health
Eatoa’s Sty ptick
Francie’ Female Elixir
Greenough's Tindure
for the Teeth
Spirits Scervy Grafs
Ean de Luce
fEtber. Baterman's
Cordial Blixic
Boftock's Elizir
Dafty's Blixir
Hooper's, Lockers &
Aaderfon’s or the
Searts Pille
Jamen's Fever Powder
Oi! Rhodium
Lavender, Mace
Cienamon, Cloves
Rofemary, Rajkos
Figgs, Corrants, Al-
monds, Tamarinda,
Spew&pirmoat waters
Rofe Water
Cold Cream
Pomatum
Ladies Court Plaifter
Spices, Surgeons Capi-
tal&pocketinfroments
Crooked Needles
Lancets
Painters Colours
A few very meat
Watches
NeckLaces EarRings
Buttona & Buckles
A very elegant Afort-
meat of Metzotinto
Pidtares, Prints,
Maps, Stationary-
ale ots Poper
sagisgs for Rooms,
wee SOOKE
fo 00 2
Account Boks of all
Sizes, blank & ruled
Lobb? medical Prin-
ciples

Hillary on the Small-
P

Ox
Brook's Pradice
Frinde on Fevers
Ramenologia
Bacon's Abrigment
Wood's laftitates
Le Strange's Jofephus
Paladio Loadinenfis
Rider's Hiflory of

England, 34 Vol.
Nature and Art
Rrvrith Plutarch
Brock ’s natural hiftory
Sm p's Laboratory

ptor

Weft and Lintletow om
the RefarreAion

Hebrew Bibles

Hiflory of the late War

Real Chrifian

New whole Duty cf
Mas

Row's Letters and
Mifcellanies

Young's Satires and

t
Paradie Loft and Ke-
grie'd
Waus's Poems, Ser-
mons, Plalms asd
Hymns
Letter Writer
SpeGator
Female ditto
Martin'sPhilofophical
Grammar, and
Philofophia Britannia
Freemafoa's Pocket
Compsaiea
Dryden's Poemo
Ben Johnfon's Works
Prior's Poeme
Pope's & Swift's works
Locke on Human Ua-
derftanding
Mariner's Compals &
Kallenders
Prefeat State Europe
Complete Houle Wife
Ward's Mathematics
Clarke's Nepos
Virgil's Delphos
Tully's Orations
Drydeos Virgil
Hervey's Meditations,
Harvey's Letters and
Disloguee
Thomfos's Seafoas
Aafun's Voyage
Quincy's Difpenfatory
and Lexicoa
Sherlock oa Provi-
dence
Huxham os Fevers
Independent Whig
Smollet’s Qsizoss
Chariffa
Grandifoa
Cryftal
Peregrine Pickle
Selmon's Grammar &
Gazetteer
Dyche's, _—_ Bailey's,
Hiftorical, and
Freach DiGionary
Gay's Fables
Pope's Homer
Sherlock om Death
Every Maa his own
Lawyer
Family Inftructor
The World
Large Bibles with A-
pocrypha
Small plain &gilt ditto
Prayer Books.
All Doddridge’s and
Booerhave's Works
M’‘haurin's Algebra
Tablet
Shaw's Pra@ice

Berryfreet Sermons

Addifon's Works

Rambler

Guardaia

Smollet's hit. Baglead

Chefelden's Anatomy

Sharp's Sargery

Hudibras

Lady's Lidtary

Tom Joags

Pamela.

Dialogoda the Deid

Apophthegms of the
cond

Dodfley's Poems

Attorney's Pradilce
King’s Beach ond
Commoa Pleas

Virtue the Source of
Plesfare

Chamberlain's Mid.
wifery

Love's Sarveyiog

Latin, Greek aad
Freach Grammare

Swan's Sydenham

New Daty Man

Armftrong oa Health

Pleafares Imagination

Law's Call

Fraacis’s Horace

Solyman & Almens

Almesa & Hamer

Raflelais

Trifram Shandy

Yorstick’s Sermoes

Jofeph Andrews

Ariflotie’s Works

Lambert's Works

Hawkine’s Plees the
Crowa

Pomfret’s Poems

Lady's Preceptor

Ellis’s PraGicad
Parmer

Pragtical Farrier

Harris’s mical
Dialoge

Lady's Fnupentiters

Art Speaking

Scott's Hymn ta Re-

tauce

Paladum's G, Britsia

Harwood em Death
Bed Repeatasce

Polite Lad

Memoirs BedfordCof.
fee Hoole

Romaace of a Night-
Vifion's Fancy

Cunningham's Coa-
templati@t

Roffean’s Emelias

Leifore Hour's amafle-
mest

Le Belle Affemble

Conftantia

A large Colledtioa of
Plays and Novels,
with many other
Books aod Pamph-
lets too numerous
to meation.

TEA, Rum, Sugar,

Fine Darham Flower
Mullard, &c. &c.

many other Articles, very cheap, for Cafh or

(hort Credit.

ONE OF BENEDICT ARNOLD'S ADVERTISEMENTS, CA. 1765

713

When she needs
a clear nose
and a clear head»

Syrup: 30 mg per
teaspoonful (5 cc);
bottles of 4 fl oz

and 1 pt.

ee
siulley nese

Burroughs Wellcome Co.
Research Triangle Park
Wellcome | North Carolina 27709

DRUG EVALUATION

Since publication of the article on Nitroglycerin Ointment in
the July, 1976 issue of The Maryland Pharmacist, a number of
readers having personal experience with the product have con-
tacted me and shared their ideas concerning some of the points
made. It seems appropriate to share these experiences with all
of the readers of The Maryland Pharmacist.

® Numerous complaints have been made about the piece of
paper used as an applicator. These range from the fact that
insufficient pieces of paper are supplied to the difficulty
involved in using them. the stated inappropriateness of using
one’s fingers to spread the ointment has been questioned,
using the argument that the amount of absorption which
might occur through the fingers during application is insig-
nificant and certainly not detrimental. This seems to bea valid
line of thinking. Certainly patients should wash their hands
after applying the ointment. However, it would still be advis-
able for persons who are administering the ointment to a
patient to use the applicator paper. Other patients have
noted that they have great difficulty in covering an eight inch
diameter area with two inches of ointment.

® Comments made to me indicate that a wide variety of
methods are used to occlude nitroglycerin ranging from light
bandaging to the use of Saran® Wrap taped on four sides with
Micro-Cel® tape. A resulting variation in percutaneous ab-
sorption and therapeutic response would be expected. Some
patients apply the ointment to the lower leg and then use a
high knee sock or stocking to hold the Saran® Wrap snugly
around the ointment-encased leg. This would appear to give

New Rx Container Requirements

All pharmacists should begin immediately to obtain prescrip-
tion container inventory which meets ‘‘tight’’ requirements,
according to the American Pharmaceutical Association’s

_ Academy of Pharmacy Practice (APP).

The Academy’s recommendation is intended to facilitate im-

_ plementation of new United States Pharmacoepia-National
_ Formulary (USP-NF) standards for moisture permeability for

prescription drug containers which become effective April 1,
1977. APP’s suggestion will permit a smooth transition to use of
the new containers and help to avert a possible shortage of
containers meeting ‘‘tight’’ standards which could result if
suppliers were deluged with last-minute orders. The standards’
effective date was originally January 1 of this year but was later
delayed to give manufacturers a chance to build an inventory
adequate for the anticipated high demand.

The standards came about asa result of testing by the National
Formulary which showed that many drug containers being used

at that time, and especially those with child-resistant features,

were inadequate to provide proper protection against atmos-
pheric moisture and gases.

NOVEMBER, 1976

Nitroglycerin Ointment Revisited

by Ralph Shangraw, Ph.D.* t+

maximum occlusion. Switching from one leg to another
would not cause any difference in absorption rate.

© A number of comments were made about switching of appli-
cation sites. The original article did not preclude this practice
but simply indicated that a change in absorption and effect
might result. Some readers interpreted this to mean that it
should not be done. According to the experiences of some
users, rotation of sites is anecessity. It is not uncommon fora
rash or irritation to result when the ointment is applied con-
tinually to the same site day after day. Patients who tightly
occlude the application site also observe softening and mac-
eration of tissues due to constant occlusion. In such instances
the site should be rotated. As indicated previously, changing
from one leg to another or one portion of the chest to another
would probably give less variability than changing from leg to
chest or vice-versa.

Nitroglycerin ointment remains a commonly employed
method of achieving long acting nitroglycerin therapy. There
seems no doubt that a more effective and aesthetic topical
product could be prepared. It is unfortunate that the industry is
so hesitant to invest research dollars in improving the dosage
form of this drug of proven usefulness. It appears that in the
case of nitroglycerin, FDA restrictions have resulted not in a
‘drug lag’, but certainly a ‘dosage form lag’’.

* The author wishes to express his appreciation to those readers who
took the time to detail their experiences with this truly unique product.

t Professor and Chairman, Department of Pharmacy, University of
Maryland School of Pharmacy.

Use of the new “tight” containers may require some addi-
tional patient education activity by the pharmacist, the Academy
points out. In some cases safety closure operational features
have been changed to ensure tightness, and many of the new
containers are being manufactured from a different plastic
material. Use of the newer material usually results in a container
which is cloudy or even opaque in appearance, making it dif-
ficult orimpossible for the patient to see the medication inside.

The Academy is currently surveying container manufacturers
regarding the availability of ‘tight’ containers so that pharma-
cists may be advised of alternate supply sources in the event a
shortage develops.

Kinnard Speaker at Auburn

Dr. William J. Kinnard, Jr., Dean of the School of Pharmacy
and President of the American Association of Colleges of Phar-
macy, participated in the Annual Fall Seminar and the dedica-
tion of the new pharmacy building at Auburn University,
November 12 and 13. Dean Kinnard spoke of the future of
pharmacy and the vital role schools like Auburn must play in
forming that future.

15

Paramount Photo Services

THE MARYLAND PHARMACIST

~

“4,

thy

ZOSIING aS

Fall Regional Meeting — Photo Coverage

Ramada Inn, Beltway — October 14, 1976

_ President Melvin N. Rubin addresses the delegates while Luncheon Speaker Bertha Finney, Medical Services Specialist,
| Speaker of the House of Delegates Victor H. Morgenroth lends Philadelphia Region, HEW.

an attentive ear.

Drug Manufacturer representatives with George A. Stevenson,

_ LAMPA MEETING: Paula Frank (second from left) of the Pikes- Chairman of the Industrial Relations Committee (seated, far
_ ville Home & Garden Center presented floral arrangement right).
demonstration. Pictured with her (left to right) are Mrs. Rose
Weiner, Membership Treasurer; Mrs. S. Ben (Bea) Friedman, Earl Kerpelman, President of the Board of Pharmacy and Par-
President, and Mrs. Louis (Dora) Rockman, Treasurer. liamentarian of the House of Delegates.

SAPhA members (left to right) Donna Mallard, Cathie Chairman of the Board Henry G. Seidman accepts the Past
Schumaker, Joe Brooks, Frank Blatt, Bonnie Levin and Luisa Presidents Award presented by John G. Bringenberg of E. R.

Massari.

NOVEMBER, 1976

Squibb.

WHAT IS ASTRO????

“OUR” — “YOUR”
ASTRO PROGRAM
IS
A SUCCESS!!!

FOR DETAILS CONTACT TOM SOMERS
301-467-2780

THE CALVERT DRUG COMPANY

901 Curtain Avenue
Baltimore, Maryland 21218

17

ational
Hezaldhs
nourance

Tire Crsmrzssse Denormbstator
of Theat Nesters
RESEARCH
us
¢t, '
ra)
A ;
%
fi eh
Ras SB ee
>

THERE ARE A

Pharmacy today is in the spotlight, subjected to all
kinds of scrutiny. Your actions are being monitored and
judged, sometimes by unknown third parties.

The worry is that in the wake of this focus, your rela-
tionships with both doctors and patients will be weakened,
without offsetting benefits. Consider three examples:

Drug substitution Until recently, state pharmacy
laws, regulations, or professional custom have stipulated
that non-generic prescriptions be filled with the precise
products prescribed. But in the last five years, a number of
these laws or regulations have been changed, permitting
you, in varying degrees, to make the selection when a
multi-source product is ordered.

These changes have been taking place against a back-
ground of growing evidence that purportedly-equivalent
drug products may be inequivalent, since neither present
drug standards nor their enforcement are optimal. In fact,
the FDA has not enforced the same standards for hun-
dreds of “follow-on” products that it has applied to orig-
inal NDA approvals. This situation, it seems to us, is a
compelling reason for product selection to rest on a sensi-
ble interchange between doctors and pharmacists—and
not on legislative action.

The major advertised claim for substitution is reduced
prescription prices for consumers. Yet no documentation
of any significant overall savings has been produced, nor is
any likely, given the needs of pharmacy and the record
of government in administering cost control programs.

MAG Maximum Allowable Cost, MAC for short, is
a federal regulation intended to cut the government's
drug bill by setting price ceilings for multi-source drugs
dispensed to Medicare and Medicaid patients. Unless the
prescriber certifies on the prescription that a particular
product is medically necessary, the government intends to
pay only for the cost of the lowest-priced, purportedly-
equivalent, generally-available product. The effect of the

LOT OF PEOPLE
GETTING BETWEEN
YOU AND THE
PATIENT.

program may be that elderly and indigent patients will be
restricted to products which someone in Washington be-
lieves are priced right, regardless of your economic or
professional judgments. Pharmacists will have little to say
about administration of the program, since government
will have absolute authority to make its prices and fees
stick. For other multi-source drugs on the MAC list, your
reimbursement would be limited to a product price on a
government “estimated acquisition cost” list and a state-
established professional fee.

The drug lag The future of drug and device research
depends upon a scientific and regulatory environment
that encourages therapeutic innovations. The American
pharmaceutical industry annually is spending more than
$1 billion of its own funds and evaluating more than
1,200 investigational compounds in clinical research.
Disease targets include cancer, atherosclerosis, viruses and
central nervous system disorders, among others. But there
is a major barrier to the flow of new drugs to patients: the
cost of the research is more than ten times what it was, per
product, in 1962, and whereas governmental clearance
of new drug applications took six months then, it com-
monly consumes two years or more now.

The FDA needs adequate time, of course, to consider
data. But it is equally clear that the present complex ap-
proval process contributes to needless delay of drug ther-
apy. That's why the increased efficiency of the drug and
device approval process is vital to all our futures.

We suggest you make your voice heard on these issues
—among your colleagues and your representatives in state
legislatures and in the U.S. Congress.

It could make a difference to patients and to the prac-

tice of your profession tomorrow.
P-M-A

Pharmaceutical Manufacturers Association

1155 Fifteenth Street, N.W., Washington, D.C. 20005

Quaint? Well, in the year 2052 A.D. how old-fashioned will
today’s pharmaceutical manufacturing facilities seem?

Make no mistake: seventy-six years ago there

was nothing quaint or nostalgic about Dr. W. C.

Abbott’s granule manufacturing operation. At
the turn of the century, when this photo was
taken, this was as modern a pharmaceutical
producing facility as could be found anywhere
in the world.

A look at Abbott’s past is a key to Abbott’s
present. When Dr. Abbott founded the Abbott
Alkaloidal Company in 1888, he set innovative

standards for his products. Early on, pharmacists

and physicians learned to expect uncompromis-
ing quality in every pharmaceutical product
that bore the Abbott name.

These standards are still inherent in every

phase of every product made by Abbott
Laboratories ... now more than a half dozen
divisions, nationwide, worldwide, with sales
exceeding a billion dollars annually.

Chances are that in the fifties . . . the twenty-
fifties... they'll be showing quaint, nostalgic
photographs of what we see as today’s sleek,
computerized pharmaceutical manufacturing
facilities. They'll seem hopelessly primitive
to the pharmacists and the physicians of that
future era. But traditions ... Abbott traditions...
being what they are, we’re confident that those
pharmacists and physicians can look to
Abbott quality just as folks did in the c)
good old days of the nineteen-seventies. “a—

ABBOTT LABORATORIES North Chicago, 1L60064 6083170

Fall Regional (Continued from Page 10)

.
|

expand sustaining membership and broaden support from
suppliers.

Another meeting will be held before the end of the year to
again review the financial status and complete the budget
recommendations for next year.

Possible payment of APhA registration fees for MPhA dele-
gates will be considered by the committee as well as a
convention issue with solicitation of advertisement on a
one-time-of-the-year basis. It was moved and seconded to
adopt the report.

. Industrial Relations Committee Report — George A.

Stevenson, Chairman. Committee meetings were held on

August 17, 1976 and September 28, 1976.

Projects:

A. The increasing of membership of pharmaceutical sales
representatives in MPhA.

Goal: One associate member (full member, if pharma-
cist) from each company; if possible, at the District
Manager level.

Actions:

* Committee members contacting their personal repre-
sentatives — some interest being shown.

® Letter from Committee to pharmacy relations mana-
gers of approximately thirty companies inviting their
Maryland District Manager to attend our Fall Regional
Meeting on October 14, 1976 — some favorable re-
sponses received — more expected.

® Letter from Nathan Gruz, Executive Director to
pharmacy-owner members of MPhA providing
reasons for our campaign, application for member-
ship forms and dues structure.

® Contacts made by George Stevenson with PMA and
NPC Pharmacy Relations Committees key personnel
asking for their help in our project.

B. Standardization of the placing of the NDC code, expira-

tion date and lot number on labels and cartons.

® Committee recommendations have been referred to
PMA and NPC Pharmacy Relations Committees for
their help.

® Nathan Gruz, Executive Director, has forwarded the
committee’s recommendations to the FDA for their
consideration.

Future projects to be considered by committee include:
problem of outdated products and their possible pick-up
by manufacturers for exchange or credit; review of distri-
butional policies of pharmaceutical manufacturers; the
making of package inserts more accessible; request to
manufacturers to provide the PDR to pharmacists; prob-
lem of obtaining bioavailability information from some
manufacturers.

MPhA members are requested to inform the committee of
any project they would like to have considered.

NOTE: The committee does not want any of its projects to
interfere in any way with the MPhA’s successful
TAMPA operations — our sphere of activity is with
the pharmaceutical industry.

NOVEMBER, 1976

After the report was presented for consideration about
twenty (20) representatives of industry who were present
were introduced. The report was then adopted.

. Consumer Affairs Committee Report — Paul Freiman,

Chairman. The first meeting of this committee was held on
September 27, 1976, at the home of the chairman. Presentin
addition to myself were Melvin Rubin, Nathan Gruz,
Donald Fedder and Philip Weiner. In addition to the phar-
macy members, Mr. John Ruth, Attorney General for con-
sumer affairs for the State of Maryland, and Estelle Cohen,
newly appointed public member of the Board of Pharmacy
and an economist who teaches at the College of Notre
Dame in Baltimore, were present.

A thorough discussion was held on the Generic Drug Bill, its
implications, and the role of the consumer in passage of a
more workable Drug Product Selection Bill. At the conclu-
sion of this discussion, Mr. Ruth said that he will use his
office in order to gather up the necessary information and
consumer support, so that the chances of success in An-
napolis will be increased this year for its passage. Also
discussed was the law that requires that only apharmacist in
a pharmacy may discuss medication with a patient whether
it be prescription or over-the-counter. At the suggestion of
Mr. Ruth, the idea of the MPhA issuing signs for members to
postin their pharmacies to advise the public of this law was
accepted by the committee. Mrs. Cohen discussed the
problems of the Board of Pharmacy and its financial bind.
Her recognition of the need of more funding was apparent
to the committee present and it was recognized that she
should make a valuable contribution to its achieving of its
purpose. A brief discussion was held on the posting law and
on the merits of patient profiles and whether they should be
mandatory. No agreement was reached on these two top-
ics;

On October 5, 1976, | appeared ona panel discussion on the
Drug Product Selection Bill. This seminar was sponsored by
the MaryPirg organization, a Ralph Nader consumer group
that is also interested in supporting this bill in Annapolis.

In conclusion, | would like to state that this first meeting,
though poorly attended by the members proved to be suc-
cessful in achieving its stated goal. The presence of John
Ruth and Estelle Cohen not only added positively to the
meeting, but also their interest in pharmacy as a profession
that is really interested in the consumer was enhanced. The
presence of John Ruth at an MPhA meeting in itself was, |
feel, a major step in the achievement of pharmacy’s goal to
be recognized as a profession working in the public’s inter-
est. Mr. Ruth promised to contact me as soon as he had all
the necessary information accumulated. At that time
another meeting of this committee will be held which will
lead hopefully to a more workable Drug Product Selection
bill for Maryland, anda greater understanding by the public
of the pharmacists role in serving the needs of the patient.

The report was adopted.

. Professional Affairs Committee — Samuel Lichter, Chair-

man. The only charge thus far directed to the committee has

(Continued on Page 23)

ry |

DENNIS CRAWFORD

DEAN SULLIVAN

BILL HYSSONG

MIKE GERSHEN

Fae?
Sap
a

BOB GITTINGS

4

Sf ei
TOM DONOVAN

BOB MUMMEY TIM BRODERICK

WE'RE PUTTING
OUR BEST FACES FORWARD

The faces of SAGF Representatives who stand ready

to help you in any way with anything to do with SKG6F.

If you have a question or a problem, just ask.
—

Smith Kline & French Laboratories V)

Division of SmithKline Corporetion

|

- Fall Regional (Continued from Page 21)

been the matter of the over-prescribing of Valium.® | have
been in contact with Dr. Noel D. List, Chairman of Med-
Chi’s Maryland Drug Abuse and Alcoholism Control Com-
mittee (MDAACC). The first meeting of this committee’s
new year, in the latter part of October, will have this matter
included on its agenda. Having been a member of this
committee (MDAACC), I can assure MPhA that some useful
dialogue will be developed.

As Chairman of the Professional Affairs Committee, | will
attempt to establish an ongoing liaison with other health
professions. The objective of this liaison is to open new and
reopen old channels of communication for the Association.
These channels will hopefully be two-way, and provide
additional recognition by others of our activities.

The committee will also address itself to the problem of the
multiprescription blank. We, as pharmacists, must under-
stand the physicians’ reasons for using such blanks, before
we ask them to stop because of problems presented to us.
The Board of Trustees needs to provide the Professional
Affairs Committee with a list of other organizations and
agencies considered to be of highest priority in its de-
velopment of the aforementioned liaison.

There was considerable discussion of the problem of illegi-
ble physicians’ signatures or lack of imprinted physicians’
names on prescription blanks contrary to Maryland law,
which has a penalty for both prescriber and pharmacist who
dispenses such a prescription. The matter will be placed on
the committee’s agenda. The report was then adopted.

. SAPhA-MPhA Joint Chapter Committee Report — Margaret

Brophy, Chairperson and President of Maryland SAPhA.
Thank you for this opportunity to report on the activities of
the SAPhA-MPhA Committee. Unfortunately, our commit-
tee has not met since it was appointed a few months ago.
Most of my free time has been devoted to completing our
membership drive and preparing for our Regional Meeting
to be held at the end of October. And so | have had no
opportunity to arrange to meet with the Committee. As you
are aware, this isa newly formed committee. As we have yet
to meet, our function has not been defined and our goals
have not been set. We are certainly open to suggestions of
all Association members on this subject.

| am aware that MPhA does not include SAPhA members in
its membership count. But! am sure that there is still a great
deal of interest in student membership. The results of this
year’s membership drive may prove interesting to some.
Last year Maryland SAPhA had 80 members. After gradua-
tion our number was decreased to 58. With these figures in
mind, | am quite pleased to announce that Maryland SAPhA
now has 151 members for the 1976-77 membership year
(effective October 1). You may want to incorporate these
figures into the report of the Membership Committee for
this next House of Delegates meeting. | hope that along
with our increase in numbers we will experience an in-
crease in student involvement! As always, we are looking
forward to participating in the MPhA House of Delegates.

Report was adopted.

NOVEMBER, 1976

a.

10.

Th.

2a

13.

Continuing Education Committee Report — Henry G.
Seidman, Chairman. The Continuing Education Committee
met on September 29, 1976 at the Kelly Memorial Building.
In attendance were members Henry Seidman, Chairman;
Noel Bosch, Nathan Friedman, Henry Verhulst, President
Melvin Rubin, and Executive Director Nathan Gruz.

Many general and specific areas of continuing education
posture both nationally and in the state were reviewed and
discussed. Special reference was made to the status of
mandatory continuing education at both these levels.
The problems of scheduling and programming to avoid
conflicts with many types of pharmacy and other functions
merited much attention. Programs which the Association
would and could do independently and those in which it
would share responsibility with the School of Pharmacy
were discussed at length. A tentative Continuing Education
Program includes the Simon Solomon Pharmacy Economics
Seminar in November, the Robert L. Swain Pharmacy Semi-
nar in the Spring, and a series of presentations jointly with
the University of Maryland, School of Pharmacy, titled,
“The Uses of Auxiliary Label Systems for Providing Patient
Information’’. This series of Seminar presentations will be
held at seven sites in the state in conjunction with meetings
of local pharmaceutical Associations in those areas such as
Allegany-Garrett County, Baltimore Metropolitan, Eastern
Shore, Anne Arundel, Prince Georges/Montgomery
County, Washington County, and Upper Bay. These semi-
nars are planned between January 1 and April 1, 1977.
The Committee is anxious to provide programs that will
attract the attention and attendance of many of our mem-
bers and invites your input.

The report was adopted.

Convention and Tours Committee Report — Ronald A.
Lubman, Chairman. Details of the forthcoming Acapulco
and Colorado trips as well as the Annual Convention at the
Carousel Hotel in Ocean City were announced.

Board of Pharmacy Report — Board President Earl Kerpel-
man reported on new pharmacy equipment regulations.
Public Relations Committee Report — Charles E. Spigel-
mire, Chairman, reported on the Association radio pro-
grams on WCAO AM & FM and the publicity campaign
arranged for the Swine Flu Vaccination project. There was a
report on materials to be distributed for Diabetes Detection
Week and the plan to publicize radio and TV programs was
discussed. The report was adopted.

Pharmacy Practices Committee Report — Paul Burkhart,
Chairman. The first meeting of the Pharmacy Practices
Committee was held on September 30, 1976. The following
members were present: Paul Burkhart, Chairman; Mel Ru-
bin, Nathan Gruz, Marvin Oed, Sol Rosenstein and Dorothy
Levy.

The meeting began by reviewing the charge to the commit-
tee as received from President Rubin. This charge had pre-
viously been distributed to all committee members. Gen-
eral discussion relative to the charge followed with the
agreement that if pharmacy is not to be mandated through
legislation then both the Board of Pharmacy and the Mary-

23

24

land Pharmaceutical Association must establish certain
standards of practice that are ongoing for the prcfession. It
was suggested that total standards of practice for every
aspect of pharmacy be established so that when various
portions of legislation are introduced a particular standard
would act as reference to the association’s position. Obvi-
ously, it is not within the purview of this committee, either
from a human or material resources standpoint, to accom-
plish such work. This activity would necessitate a special
committee. It was noted that the Institutional Pharmacy

Regulations, which had been submitted to the Maryland

Pharmaceutical Association by the Maryland Society of

Hospital Pharmacists, required three years in their prepara-
tion. The committee decided to narrow its scope regarding
the charge and address itself specifically to:

A. Continuing Education — certification of pharmacists.

B. Patient Profiles and Pharmacy Accreditation — for the
voluntary use of these profiles.

C. The establishment of an academy for pharmacists who
had been accredited both for continuing education
and the use of voluntary patient profiles.

A. Establish criteria and methodology for certifying phar-
macists who have voluntarily completed a prescribed
number of continuing education credits.

MPhA has supported continuing education and has pro-

vided continuing education on a regular basis.

Discussion followed regarding last year’s continuing
education bill and the defeat of that legislation. It was
noted that one of the primary reasons for the defeat was
due to the lack of funds to establish the proposed coun-
cil outlined in the bill.

Current activities regarding continuing education are
centered around the Tripartite Committee and the
Board of Pharmacy. It was suggested that this Commit-
tee propose standards to the Tripartite Committee con-
cerning continuing education. Ohio was singled out as
one of these states. The activities of the Ohio Board of
Pharmacy were outlined briefly and circulated to the
committee for review at the next meeting. It was noted
that the Ohio Board of Pharmacy in announcing its con-
tinuing education program, had previously reviewed, by
survey, all programs available for the pharmacists regis-
tered in their state. The programs were accredited and
certain criteria for continuing education were estab-
lished. The phase-in period for continuing education
credit was extended overa three year period. Inan effort
to gain more information regarding national activities,
the chairman of the committee will invite Dr. Ralph
Shangraw, University of Maryland, School of Pharmacy,
to the next scheduled meeting.
The committee agreed with the president's charge rela-
tive to the certification and will study the matter further.
B. Establish methods of accrediting pharmacies maintain-
ing and utilizing patient profiles in accordance with ac-
cepted APhA standards.
The committee discussed legislative activities of last year
relative to patient profiles. The long form of Delegate
Hickman’s bill on patient profiles was reviewed so that

the committee would have an awareness of the kinds of
information that should be included on these docu-
ments. It was also noted that this legislation, last year,
had been changed to an enabling act charging the Board
of Pharmacy with promulgating rules and regulations
with respect to patient profiles. The legislation was not
passed. The committee further discussed the MPhA pol-
icy on medication profiles adapted from the Academy of
Pharmaceutical Practice of the APhA, and felt that MPhA
could point to this policy as representing a standard of
practice for profiles. It was decided by the committee
that specifics on accreditation of pharmacies utilizing
patient profiles would be pursued.

Areas for future discussion will include:

1. Recognition — possible provision of certification for
posting in APhA approved pharmacies.

2. Monitoring — should or should not the association
inspect certified pharmacies.

3. Possible reimbursement

a. It was noted that reimbursement to pharmacists is
now on-going for consultation regarding drugs
used in treating hemophiliacs in the state of Ohio
by the Ohio Blue Cross.

b. Similar reimbursement had been made for coun-
seling of patients utilizing the drug, Cytazar.

Specific questions the committee felt should be
addressed were:

1. Who will certify the pharmacists?

. Who will decide what courses will be taken?

. Who will fund these programs?

. Who will teach the necessary courses?

. What efforts to date has the association provided in
promoting continuing education to meet the needs
of individual members?

The committee, upon its decision to support accreditating
pharmacies utilizing patient profiles and establishing cer-
tification for pharmacists voluntarily completing continuing
education credits, will now pursue the information neces-
sary to adequately assess these two areas before moving on
toward proposing plans for possible implementation.

a B&W KN

In the absence of the chairman the report was presented by
Mr. Rubin and adopted.

14. Prescriptions Insurance Programs Committee Report — In
the absence of Chairman Marvin Friedman, Mr. Rubin
commented on some of the computer problems in
Medicaid emphasizing the need to place the usual and
customary fee on all Medicaid prescriptions. The State
“cost of filling a prescription” survey was discussed.

OLD BUSINESS

1. Presentation of amendments to the Constitution and By-
Laws. Speaker Morgenroth turned the chair over to Vice
Speaker Lichter to present the report. Amendments to Con-
stitution and By-Laws distributed for study. Will be voted on
at Spring Regional Meeting. Speaker Morgenroth then as-
sumed the chair again.

(Continued on Page 27)

THE MARYLAND PHARMACIST

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Eastern Shore
Pharmaceutical Society

The Eastern Shore Pharmaceutical Society meeting was held
at the Tidewater Inn, October 31, 1976. Following the social
hour, President Jerry L. Overbeck of Salisbury called upon
MPhA Executive Director Nathan |. Gruz to deliver the invoca-
tion. Following dinner President Overbeck presented William
C. Hill of Easton to introduce the guest speaker William E.
Woods, the Washington Representative and Associate General
Counsel of the National Association of Retail Druggists. Mr.
Woods, who has been selected as the Executive Director of the
NARD with offices in Washington effective January 1, presented
an overview of national legislation and NARD programs di-
rected at assisting the owners of independent pharmacies.

Mr. Gruz was then presented to report upon the activities and
programs of MPhA. He in turn introduced Melvin N. Rubin,
MPhA President, who made a report of his activities and urged
the participation of all Eastern Shore pharmacists in MPhA.

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Joint MPhA-MSHP Meeting
Scheduled January 13, 1977

A joint meeting of the Maryland Pharmaceutical Association
and Maryland Society of Hospital Pharmacists has been sched-
uled for Thursday, January 13, 1977. The subject will be a pres-
entation of the program entitled, “The Use of Auxiliary Labeling
Systems for Providing Patient Information’, designed to be
presented in cooperation with the Maryland Pharmaceutical
Association and local pharmaceutical groups. The project is an
outgrowth of concern of MPhA which placed the matter before
the Tripartite Committee. The project is under the direction of
Dr. Ralph Shangraw and Donald Fedder of the University of
Maryland School of Pharmacy faculty. Details on the program
will be mailed out. All pharmacists are cordially invited and
urged to attend.

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26

THE MARYLAND PHARMACIST

Fall Regional (Continued from Page 24)

2. APhA and NARD dues. The matter previously tabled at the
Convention of withholding dues from the national organiza-
tions was considered. Consensus was that with the opportu-
nity in 1977 to attend, observe and participate in both na-
tional conventions because of their proximity, APhA in New
York in May and NARD in Washington in October, no action
should be taken at this time.

The House of Delegates then recessed for lunch. The lunch-
eon speaker was Ms. Bertha Finney, Medical Services
Specialist of the HEW Philadelphia Region, who spoke on
HMO'’s and health care delivery — where does pharmacy fit
in and how pharmacies can start an HMO. After a discussion
of possible actions by MPhA in seeking resolution of HMO
problems, the House of Delegates reconvened at 2:15 P.M.

NEW BUSINESS

1. Approval of appointment of Executive Director. President
Rubin reported the action of the Board of Trustees on Oc-
tober 7, 1976 and requested the approval of the appointment
of Mr. Gruz as Executive Director on an interim basis as the
Board of Trustees recommended. Mr. Lachman then moved
for the appointment of Mr. Gruz as Executive Director forthe
year ending at the June Convention 1977. Seconded. The
motion was challenged as contrary to the Association’s con-
stitution. The chair called upon Mr. Earl Kerpelman, par-
liamentarian, who ruled the motion on the floor out of order,
but stated that a motion to amend the Board’s recommenda-
tion would be in order. Mr. Lachman then moved for ap-
proval of the Board of Trustees recommendation with the
amendment to state that the interim appointment period of
Mr. Gruz be until the next MPhA convention in June 1977.
Motion was seconded and passed.

2. HMO’s — Donald Schumer reported on the problems con-
cerning prescriptions filled by HMO’s and not paid.

3. Resolution presented by the joint SAPhA-MPhA Chapter:

Professional Unity In Maryland

Whereas the need for professional unity is widely recognized by
various factions within the profession of pharmacy;

Whereas action is being taken to attempt to achieve this unity
(as evidenced by recent communications between APhA &
NARD);

And whereas we view the existence of two separate organiza
tions, MPhA and MSHP, as unnecessary and even detri:
mental to the profession of pharmacy in Maryland;

Be it resolved that MPhA take active measures to improve and
expand relations with MSHP;

And be it further resolved that such measures be undertaken
with the ultimate goal of establishing one unified organiza-
tion for pharmacists in the state of Maryland.

On motion of Mr. Ben Friedman, seconded and passed.

4. Resolution on pornographic reading material presented by
Mr. Dorsch on behalf of George Stevenson. The resolution
emphasized the objectives of MPhA as a professional phar-
macy organization dedicated to the improvement of health

NOVEMBER, 1976

care services. It pointed out that pornographic and obscene
printed matter was incompatible with this and condemned
their sale. It urged members not to distribute or sell such
items. The motion was seconded but defeated.

5. Legislative Committee — Mr. Parker moved for adoption of
the report including support of Drug Product Selection and
to leave the matter of mandatory patient profiles to the Legis-
lative Committee. Mr. Rubin moved for consideration by the
Tripartite Committee for mandatory continuing education
through Board of Pharmacy regulations. Seconded and
passed.

6. MPhA Standard Patient Profile Cards — Vincent Gattone’s
suggestion for distribution of such acard to members will be
referred to the appropriate committee for study.

7. HMO Problems — Don Schumer then presented a state-
ment. See article, ‘Open Forum” presented elsewhere in
this issue.

8. Areport was also received from James B. Culp, Jr., Chairman
of the School of Pharmacy Committee as follows:

With today’s health care system rapidly changing, the ques-
tion arises: Are we really preparing our pharmacy students
with the necessary knowledge for today’s professional prac-
tice?

It was with this idea in mind, the Pharmacy School Commit-
tee was organized. Its main function is to help bridge the gap
between pharmacists in their current practice and pharmacy
school in their current curriculum. Although this committee
has just recently been organized, it is hopeful it will open
new lines of communication and ideas for the betterment of
the profession of pharmacy.

Excellent headway has already been accomplished in the
creation of the Professional Experience Program (P.E.P.).
P.E.P. enables the fifth year student to work one month
under the supervision of an experienced pharmacist in his or
her own practice, whether it be community, hospital, indus-
trial or other. With this daily exposure, the student can gain
experience, as well as put school book theories into practice.
The program has been highly successful, growing from criti-
cism to the model for similar programs around the country.
The P.E.P. staffis now currently setting up criteria for promo-
tions in the faculty rank of preceptors.

Also within pharmacy school itself, the Professional Pro-
grams Task Force has begun the task of defining the profes-
sional program curriculum by discussing goals or general
criteria for the future education of pharmacists. A complete
report will follow shortly when details have been discussed.

9. State Cost of Filling a Prescription Survey — Mr. Yaffe urged
that steps be taken to get pharmacists to return their surveys.

GOOD AND WELFARE

1. Arecent NBC broadcast pointing out services of pharmacists
should be publicized.

2. Mr. Lichter suggested that various reports from officers and
committee chairmen be submitted early enough for inclu-
sion in the Spring Regional agenda along with the APhA
Annual Meeting reports.

The meeting was adjourned at 4:00 P.M. a

27

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Obituaries

HOWARD L. GORDY

Howard L. Gordy of Salisbury, past president of the Maryland
Pharmaceutical Association for 1950-51, died October 14, at the
age of 74. He served as a member of the Maryland Board of
Pharmacy for two terms from 1962 to 1972.

Mr. Gordy was born at Laurel, Delaware July 13, 1902. Shortly
after his graduation from the University of Maryland School of
Pharmacy in 1922, he opened Gordy’s Pharmacy in Salisbury
which he operated until 1972. He served as the first president of
the reactivated Eastern Shore Pharmaceutical Society in 1963. It
adopted By-Laws requiring its members to be members of
MPhA, the first local association to so affiliate with the state
association.

He was amember of the Salisbury Chamber of Commerce, a
33rd degree Mason, life member of Wicomico Lodge No. 91,
Eastern Shore Shrine Club, Boumi Temple of Baltimore, Past
Grand Tall Cedar of Eastern Shore Forest No. 53 and York and
Scottish Rite bodies. At the time of his death, Mr. Gordy was
serving as President of the Wicomico Chapter of the American
Association of Retired Persons. He was a member of the Rock-
awalkin Ruitan Club.

Mr. Gordy is survived by his wife, the former Hilda Causey, a
daughter, Mrs. Betty Anne Shillinger and a son, Howard L.
Gordy, Jr., minister of Trinity Methodist Church where the
Gordys worship. A brother, John W. Gordy lives in Adelphi.

DAVID FIBUS

David Fibus, 75, who had owned Fibus Pharmacy, died on
November 18. In addition to his own pharmacy, Mr. Fibus had
also worked for Cooper Pharmacy and Parkville Pharmacy, both
in Baltimore. Mr. Fibus was a long-time member of MPhA.

IRVIN SHURE

Irvin Shure, 62, owner of Irvin Shure Drug Company, died on
November 14. Mr. Shure had also worked for Sinai Hospital,
Leader Drug, and Frederick Memorial Hospital.

A.C.A. Delmarva Chapter

The American College of Apothecaries has approved the for-
mation of the Delmarva Chapter of the A.C.A., Joseph U.
Dorsch, Regional Director of Region No. 3 has announced. The
following fellows of the A.C.A. were elected to head the local
chapter for the coming year. Chairman: Fellow Herbert J.
Burns, Co-Chairman: Richard A. Metz, Treasurer: Dudley A.
Demarest, Secretary: Barbara E. Dorsch.

The Board of Directors of A.C.A. will meet in Sanibel Island,
Florida, January 27 to 29, 1977. Plans have also been completed
forthe A.C.A. mid-year in Oklahoma City, March 11 to 13, 1977.
Further information can be obtained from Chairman Herbert J.
Burns, 5903 Hilltop Avenue, Baltimore, Md. 21207.

NOVEMBER, 1976

Open Forum
Third Party Rx Programs

The following statement was written during the Fall Regional
Meeting of the MPhA House of Delegates on Thursday, October
4, 1976, at the Ramada Inn by Donald Schumer of Baltimore. Mr.
Schumer, a member of the MPhA Rx Insurance Programs Com-
mittee, delivered these remarks during the discussion of
Medicaid — MAC/EAC — HMO problems.

We have finally reached the time in the practice of providing
pharmaceutical services where astand must be taken in order to
insure our ability to operate in the future. Since the inception ot
the third party programs, we as providers have been offered a
set professional fee on a take-it-or-leave-it basis with no power
for arbitration. The advent of the HMO program and the MAC/
EAC program has insured the financial failure of many phar-
macies in the near future.

| could spend an hour or more discussing all the problems
created by the government, but | know you are aware of them,
otherwise, you wouldn't be here today. The state has provided
us with nothing but empty promises, and we are in our present
position of being unable to do anything to counteract their
blatant disregard for the needs of the providers of health ser-
vices. | pose one question. Why is it necessary that providers of
health services to the needy have to subsidize the programs in
order to provide these services?

There is no doubt that within the next 2 to 3 years, 25% to 50%
of these providers will no longer be in operation.

By law we are not allowed to take any joint action and take a
stand on what we know to be just. As it appears to me at this
juncture, we have no choice but to act on a united front and take
our chance with the courts or close our pharmacy departments
now to prevent the inevitable mental, physical and financial
suffering we are guaranteed under present conditions.

| want so desperately to believe that there is yet some justice
in our country. Before seeing many fellow pharmacists fall by
the wayside, | would hope that they unite to make their prob-
lems known to the public, the legislators and the courts.

| would rather take my chance with the courts now than face
what the future holds for us under the current conditions. This
is a problem | cannot tackle myself. | need the support of every
one of you. If you don’t unite now under a unified effort to
correct these ills, your future demise will be at your own hands.

Donald Schumer, R.Ph.
Baltimore, Maryland

CHANGE OF ADDRESS
When you move—

Please inform this office four weeks in advance to avoid
undelivered issues.

"The Maryland Pharmacist" is not forwarded by the Post
Office when you move.

To insure delivery of ''The Maryland Pharmacist'’ and all

mail, kindly notify the office when you plan to move
and state the effective date. APhA members—please in-
clude APhA number.

Thank you for your cooperation.
Nathan |. Gruz, Editor
Maryland Pharmacist
650 West Lombard Street
Baltimore, Maryland 21201

4

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THE MARYLAND PHARMACIST

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VARYLAND
2?>HARMACIST
Mfficial Journal of

‘he Maryland
JECEMBER, 1976
/OL 52

*harmaceutical
\ssociation

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THE MARYLAND PHARMACIST

650 WEST LOMBARD STREET
BALTIMORE MARYLAND 21201
TELEPHONE 301/727-0746

DECEMBER 1976 VOL 52 NO 12

CONTENTS

Editorial
7 An Assessment of 1976 — Hopes for 1977
— Nathan I. Gruz

Special Feature
19 Consumer Information Poster

Articles

8 Tricyclic Antidepressant Poisoning

— Gary M. Oderda
12. A History of the School of Pharmacy,

University of Maryland
—B. F. Allen

16 Francis S. Balassone Memorial Lecture and Tribute
28 Simon Solomon Pharmacy Economics Seminar

Departments
7 Calendar 31 Obituaries
25. MPhA News 32. MPhA Travel Bulletin

On the front cover: The drawing by William C. Ressler of the University of Maryland School of
Pharmacy is courtesy of Smith Kline & French Laboratories.

ADVERTISERS
34 Burroughs Wellcome 6 Mayer & Steinberg, Inc.
27 Calvert Drug Company 33 Maryland News
30 District Photo 32 Norciiff Thayer
3 Eli Lilly & Company, Inc. 26 Paramount Photo Service
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9-10 Lederle Pharmaceuticals 22 The Upjohn Company

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Change of address may be made by sending old address (as it appears on your journal) and new address
with zip code number. Allow four weeks for changeover. APhA members — please include APhA number.

The Maryland Pharmacist is published monthly, except for January, February, and March, 1976, combined,
by the Maryland Pharmaceutical Association, 650 West Lombard Street, Baltimore, Maryland 21201. Annual
Subscription — United States and foreign, $15 a year; single copies, $1.50. Members of the Maryland
Pharmaceutical Association receive The Maryland Pharmacist each month as part of their annual member-
ship dues. Entered as second class matter December 10, 1925, at the Post Office at Baltimore, Maryland,
under the Act of March 8, 1879.

NATHAN |. GRUZ, Editor
RICHARD M. SCHULZ, Assistant Editor
HERMAN BLOOM, Photographer

OFFICERS & BOARD OF TRUSTEES
1976-77

Honorary President

MORRIS LINDENBAUM

President

MELVIN N. RUBIN—Baltimore

Vice President

JAMES W. TRUITT, JR.—Federalsburg
Treasurer

ANTHONY G. PADUSSIS—Timonium
Executive Director

NATHAN I. GRUZ—Baltimore

TRUSTEES

HENRY G. SEIDMAN, Chairman
Baltimore

LEONARD J. DeMINO (1978)
Wheaton

S. BEN FRIEDMAN (1979)
Potomac

RONALD A. LUBMAN (1979)
Baltimore

ROBERT J. MARTIN (1977)
LaVale

ROBERT E. SNYDER (1978)
Baltimore

STANLEY J. YAFFE (1977)
Odenton

EX-OFFICIO MEMBER
WILLIAM J. KINNARD, JR.—Baltimore

HOUSE OF DELEGATES

Speaker
VICTOR H. MORGENROTH, JR.—Ellicott
City

Vice Speaker

SAMUEL LICHTER—Randallstown

Secretary

NATHAN I. GRUZ—Baltimore

MARYLAND BOARD OF PHARMACY

Honorary President

FRANK BLOCK—Baltimore
President

1. EARL KERPELMAN—Salisbury
BERNARD B. LACHMAN—Pikesville
RALPH T. QUARLES, SR.—Baltimore
CHARLES H. TREGOE—Parkton
Secretary

ROBERT E. SNYDER—Baltimore

THE MARYLAND PHARMACIST

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THE MARYLAND PHARMACIST

editorial

AN ASSESSMENT OF 1976
— HOPES FOR 1977

In 1976 more pharmacists responded to the ancient cry
of ‘‘in unity there is strength.”” More pharmacists, par-
ticularly graduates of recent years joined their state pro-
fessional pharmaceutical society. In addition, more from
both chain and independent management were at last
motivated to contribute substantial sums to
PHARMPAC, the pharmacists political action arm.

Although we are still suffering from the absence of all
too many pharmacists from all sectors of pharmacy,
increased membership and PHARMPAC support ena-
bled MPhA to proceed more aggressively from a position
of greater numerical strength and greater funding. This
strengthened posture made possible our progress in re-
solving some of the problems we faced.

MPhA’s victories in the state MAC-EAC battle pre-
vented the use of drug cost price lists that would have
been damaging. Upon MPhA’s insistence equity in pric-
ing has been largely achieved and a system of regular
updating of prices with minimum delay has been effec-
tuated. Our efforts have elicited commitment from the
_ State to assume responsibility for payment for all pres-
criptions dispensed pursuant to all valid Medicaid I.D.
cards. As to a Medicaid fee increase, the State at the
highest levels promised MPhA action based upon the
results of acost survey. The ill-advised award of a survey
contract to a firm unfamiliar with pharmacy operations
adversely affected the initial timetable as the contractor
has failed to date to come up with valid data that can be
used with confidence. We have been reassured that a fee
increase will definitely be recommended. Fortunately
MPhA did commission a survey in 1976 and these results
(published in the September issue of THE MARYLAND
PHARMACIST) have been offered and are being reviewed
by the State.

Two new committees — Pharmacy Consumer Affairs
and Industrial Relations have developed active programs
and made substantial progress.

In the legislative area, again there was an excellent box
score in supporting positive proposals and in preventing
passage of adverse laws. Consumer support has been
enlisted in support of an effective ‘‘Drug Product Selec-
tion Bill’’ which should receive excellent consideration
by the legislature in 1977. The Tripartite Committee has
endorsed a patient profile bill and a continuing education
requirement with responsibility for implementation by
the Board of Pharmacy.

In the area of Standards of Practice, a solid beginning
was made and steps have been taken to work with all the

DECEMBER, 1976

health professions in a ‘‘Joint Practices Committee’’ of
the Medical Society and allied health professions.

MPhA participated in the Pharmacy Bicentennial Ob-
servance and included appropriate programs in the
agenda of our functions. The Francis Balassone Memor-
ial Lecture, first proposed by MPhA, and joined in spon-
sorship by the Alumni Association was presented under
the auspices of the School of Pharmacy. Also in the area
of continuing education, we conducted worthwhile pro-
grams: the Robert L. Swain Pharmacy Seminar, the
Simon Solomon Economics Seminar and the bioavail-
ability workshop at our Annual Convention.

Conferences with state regulatory officials regarding
new inspection procedures for pharmacies have brought
modifications. Much remains to be done both by the
State in recognizing professional considerations and by
those pharmacists who need to give greater attention to
some of the limitless details of the overwhelming mass of
both federal and state laws and regulations.

As usual in pharmaceutical association affairs all was
not peaches and cream. Internal differences sapped time
and energies better devoted to the many professional,
economic and governmental headaches which are press-
ing us. Perhaps before 1977 closes there will be signifi-
cant progress toward constructive solutions to some of
the plagues which are within our power to ameliorate.

a Nathatils Gruz

calendar

March 5-13 — MPhA Skiing Trip to Vail, Colorado

March 17 (Thursday) — MPhA Swain Seminar —
Quality Court, Towson, “Regulatory Agen-
cies and the Pharmacist.”’

March 20 (Sunday) — U. of M. School of Pharmacy
Annual Alumni Dinner Meeting, Martins West

March 27-April 1 — International Symposium on
Drug Activity, Jerusalem, Israel

March 28-30 — NARD National Legislative and
Public Affairs Conference, Washington, D.C.

April 17 (Sunday) — AZO Fritz Berman Seminar,
Holiday Inn, Baltimore Beltway Exit 17

April 21 (Thursday) — MPhA Regional and House
of Delegates Meeting, Friendship Inter-
national Hotel

May 15-19 — APhA Convention, New York City

June 2 (Thursday) — U. of M. School of Pharmacy
Alumni Association Banquet, Eudowood
Gardens

June 17-19 — MSHP Seminar, Sheraton Hotel,
Ocean City, Maryland

June 19-22 — MPhA Annual Convention, Carousel

Hotel, Ocean City, Maryland

Tricyclic Antidepressant Poisoning *

by Gary M. Oderda, Pharm.D.+

Overdoses of tricyclic antidepressants (TCAs) — imi-
pramine, amitriptyline, doxepin and related compounds
— may produce a potentially life threatening intoxica-
tion. Since these drugs are used for the treatment of
depression, these patients are at high risk for potential
suicide attempts.

Absorption and Fate

In therapeutic doses TCAs are rapidly absorbed from
the GI tract; complete absorption of amitriptyline occurs
within 30-60 minutes.! In overdoses, however, anti-
cholinergic effects decrease GI motility and thus absorp-
tion is delayed.

TCAs bind to protein and in fact the blood:tissue ratio
varies from 1:10 to 1:30.” The primary route of excretion
is via metabolism in the liver to active and inactive
metabolites which are then excreted in the urine. Ami-
triptyline is first N-demethylated, then further de-
methylation and hydroxylation occur. Virtually the en-
tire dose is excreted as the glucuronide or sulfate conju-
gate of these metabolites. Little unchanged amitriptyline
appears in the urine.!

Following an oral radioactive dose of amitriptyline,
approximately 63% appears in the urine in 7 days with
about 27% in the first 24 hours. Approximately 10.5% of
a single oral dose is excreted in the feces during the same
7 day period.! Since amitriptyline is found in the feces
following an intravenous dose, biliary excretion is most
likely responsible for this finding. Following oral
administration of a single dose of amitriptyline the
plasma half life is approximately 32-40 hours. !

Drug Interactions

Clinically significant drug interactions are well
documented. The following are examples of the types of
drug interactions that occur. For a complete listing see
Drug Interactions, Philip D. Hansten, 3rd Edition, Lea
and Febiger, 1976.

1) Guanethidine. TCAs block the uptake of guanethi-
dine into the adrenergic neuron and thus inhibit the anti-
hypertensive effect.’

2) Epinephrine and Levarterenol. When either epine-
phrine or levarterenol are given to patients taking TCAs,
an exaggerated pressor response is seen. Dysrhythmias
have also been reported.?

3) Anticholinergics. When other drugs with anti-

"This article is intended to be a basic overview of Tricyclic Antide-
pressant Poisoning that would provide the practicing pharmacist with

useful information. If further information is desired, contact the
author.

¢Director, Maryland Poison Information Center
University of Maryland School of Pharmacy

8

cholinergic effects are taken, additive anticholinergic
effects are seen. This includes such drugs as antihista-
mines, phenothiazines, antiparkinson drugs and glute-
thimide.*

Inherent Toxicity

Discussion of potentially fatal doses of TCAs is diffi-
cult since there is so much individual variation. Patients
have survived doses that are much greater than those
considered potentially lethal. If one consideres ami-
triptyline for example, fatalities have been reported fol-
lowing the ingestion of as little as about 500 mg in an adult
and between 375 and 500 mg in a 2 year old child. Yet,
survival has occurred following an acute dose of 3925 mg
(157 25 mg tablets) in an adult* and 1750 mg (135 mg/kg) in
a 2 year old child.®

If one considers one gram to be a potentially lethal
dose, an adult patient maintained on 150 mg of amitripty-
line per day would have this amount in as little as a one
week supply. The acute ingestion of a month’s supply,
4500 mg, is potentially fatal in most adults and thus
dispensing large quantities of TCAs is to be discouraged.

Clinical Effects

Major side effects seen following therapeutic doses of
TCAs include CNS depression, orthostatic hypotension,
arrhythmias, anticholinergic symptoms, such as blurred
vision, dry mouth, constipation, urinary retention,
tachycardia, and arrhythmias. Many of these effects are
also seen following large acute doses.

Acute overdoses produce toxicity in two major areas:
the central and peripheral nervous systems and the
cardiovascular system. Central nervous system effects
are usually the first toxic signs encountered. Effects of
central nervous system depression including agitation,
lethargy, delirium and coma are seen. The coma pro-
duced by TCAs is usually of relatively short duration —
18-24 hours. Hallucinations and convulsions are seen in
some patients as well as muscle twitching, and move-
ment disorders such as myoclonus and choreoathetosis.°®
Respiratory depression may also occur.

Peripheral anticholinergic effects, e.g., dry mouth, di-
lated pupils, decreased GI motility, urinary retention,
commonly occur. Both hypo and hypertension have
been reported. It has been theorized that since TCAs
deplete norepinephrine from axonal granular stores and
block its reuptake into the axon, the initial hypertension
may be a result of the released norepinephrine. As the
norepinephrine is broken down by MAO and COMT,
hypotension occurs.’ The alpha blockade produced by
TCAs may also produce the hypotension.’

The effects on the cardiovascular system are both
complex and the potentially most life threatening.

THE MARYLAND PHARMACIST

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Tricyclic (Continued from page 8)

Arrhythmias of almost every type have been reported
including supraventricular tachycardia, ventricular
tachycardia, bundle branch block, atrioventricular
block, etc. Some of the cardiovascular effects are anti-
cholinergic in nature and others are thought to be a direct
effect of TCAs on the myocardium. Since fatal arrhyth-
mias have been reported as late as 6 days after ingestion,
careful cardiac monitoring is critical.*

Treatment

1) Supportive therapy as with other intoxications, espe-
cially of the respiratory and cardiovascular systems,
is of critical importance.

2) Decrease absorption. Emesis or lavage followed by
activated charcoal and a saline cathartic are indicated
even several hours after ingestion. For a further des-
cription of these processes see the MARYLAND
PHARMACIST, January 1974 and February 1974.

3) Hypotension should first be managed with IV fluids.
Pressor agents may be used if needed but must be
used cautiously in these patients because of their
arrhythmogenic potential.

4) Antidote. The TCA anticholinergic effects may be
reversed with an anticholinesterase agent such as
physostigmine. Physostigmine is preferred over neo-
stigmine since the former is a tertiary amine and will
cross the blood brain barrier and reverse central anti-
cholinergic effects. Although physostigmine will re-
verse dry mouth, CNS depression, etc., it should not
be used for this purpose but rather to treat only severe
symptoms such as convulsions, severe hallucina-
tions, hypertension and arrhythmias.® Physostigmine
should be administered slowly intravenously. Since
its duration of action is short, it may need to be
repeated as frequently as every 30-60 minutes if
symptoms recur.

5) Convulsions unresponsive to physostigmine should
be treated with IV diazepam.

6) Arrhythmias unresponsive to physostigmine may be
treated with intravenous phenytoin.

7) Forced diuresis, peritoneal dialysis or hemodialysis
are NOT effective and should not be considered.

Acknowledgements

Special thanks to Jacquelyn Lucy, M.A., M.Ed.,
Robert Varipapa and Ethyl Frost for reviewing the
manuscript and to Annette Byers for typing.

References

1Blavil Product Information, Merck Sharp and Dohme.

2Rumack, B., Tricyclic Antidepressant Management, Poisindex, Micromedix,
Denver, CO, 1976.

3Hansten, P., Drug Interactions, 3rd Edition, Lea and Febiger, Philadelphia,
1976.

4Lewis, S., Oswald, I., Brit. J. Psychiat., 115:1403, 1969.

5Kollberg, H., Su. Lak. Tidn., 61:3638, (Nov. 18) 1964.

6Burks, J., Walker, J., Rumack, B., Ott, J., Tricyclic Antidepressant Poisoning
— Reversal of Coma, Choreoathetosis and Myoclonus by Physostigmine, J.
Am. Med. Assoc., 230(10):1405-1407, (Dec. 9) 1974.

Bryan, C., Ludy, J., Hak, S., Roberts, R., and Marshall, W., Overdoses with
Tricyclic Antidepressants — two case reports, Drug Intell. and Clin. Pharm.,
10:380-384, (July) 1976.

8Crocker, J. and Morton, B., Tricyclic (Antidepressant) Drug Toxicity, Clin.
Toxicol., 2:397, 1969.

DECEFMRFER 1976

International Symposium on
Drug Activity Set for
Israel in March

An International Symposium on Drug Activity will be
held in Jerusalem, Israel, from March 27 to April 1, 1977.
Organized by the Hebrew University School of Phar-
macy and sponsored by the International Pharmaceu-
tical Federation (FIP) Board of Pharmaceutical Scirenc-
es, this international meeting will provide an opportunity
to exchange ideas with scientists from all parts of the
world on drug metabolism, pharmacokinetics, bioavail-
ability, drug delivery systems and biochemical ap-
proaches to medical research and development.

The symposium opens Sunday, March 27, 1977, with
plenary scientific lectures schedules for Monday and
Tuesday mornings, March 28-29. Scientific symposia are
set for the same afternoons, with a special session on
pharmaceutical education to be held Monday evening,
March 28. Wednesday, March 30 is to be devoted to
professional tours, and Thursday, March 31 will include
a scientific session and the presentation of papers. The
symposium concludes Friday morning, April 1, with a
panel session.

General Chairman is Dr. Joshua Kohlberg of Tel Aviv,
with Associate Dean Avraham Kreiser of the Hebrew
University School of Pharmacy as Organizing Chairman.
Dr. Gerhard Levy of Buffalo, New York; and Professor
S. Sarel of Jerusalem serve as joint Scientific Chairmen.

Registration fees have been set at $100 ($120 after
January 1, 1977, for participants), and $60 for accom-
panying persons.

Three different tours sponsored by the American
Pharmaceutical Association have been organized by
Group Travel Unlimited, Inc. of Washington, D.C. in
cooperation with Compass Tours/Peltours and El Al Is-
rael Airlines for those attending this major international
conference. Tour 1 consists of 11 days in Israel departing
New York City March 26 and returning April 5; while
Tour 2 includes 14 days in Israel departing New York
City March 19 and returning April 1. Tour 3 offers 11
days in Israel plus two days in Athens and a three-day
cruise; this tour departs New York City on March 26 and
returns on April 11.

For registration and accommodation forms as wellas a
detailed tour brochure with both a group travel registra-
tion form and an individual travel registration form, write
APhA Division of Communications, 2215 Constitution
Avenue, N.W., Washington, D.C. 20037.

ETE E EIT IIIEII ERD

Seminar Note: Register NOW for the Robert L. Swain
Pharmacy Seminar, March 17, 1977 at the Quality Inn,
Towson, by contacting the MPhA office, 727-0746.

EEE EEE

I]

OLDEST IN THE SOUTH

A History of the School of Pharmacy
University of Maryland

By B. F. Allen, Ph.D.*

The first suggestion of a College of Pharmacy in Balti-
more emanated from Dr. William R. Fisher (he held the
degree of M.D.), a native of Philadelphia, who settled
here in 1827 at the age of nineteen, and established a
pharmacy in the city about 1834. He was Professor of
Botany inthe School of Arts and Sciences of this Univer-
sity and one of the leading spirits in the Maryland Acad-
emy of Science and Literature. In 1837, he was made
professor of Chemistry in the School of Medicine.

Of Dr. Fisher’s ‘‘plan’’ nothing is known except that
he had formed one, and that it met with favor among his
colleagues of the Medical and Chirurgical Faculty. A
sudden illness prevented his participation in its execu-
tion. He returned to Philadelphia in 1839 and recovered
sufficiently to occupy a professorship in the Philadelphia
College of Pharmacy. He died at Hohnesburg, near
Philadelphia, in 1842 at the early age of thirty-four.

In 1837, aconvention of Eastern Shore physicians who
met in Easton, Maryland made a demand on the General
Assembly in Annapolis for the establishment of a college
of pharmacy.

The School of Pharmacy of the University of Mary-
land, originally the Maryland College of Pharmacy, is
now in the one hundred and thirty-fifth year of its exist-
ence (the oldest Pharmacy School of the south). In 1841,
there were seventy-seven drug stores in Baltimore City.
The more forward-looking proprietors of these stores
realized that broader and more thorough education and
training than could be obtained through employment ina
drug store must be provided for their apprentices if the
citizens of the Commonwealth were to be properly
served. These proprietors joined with some of the more
progressive physicians of Baltimore City (several were
associated with the University of Maryland) in organiz-
ing the Maryland College of Pharmacy, which was incor-
porated on January 27, 1841, and which began to func-
tion as a teaching institution in November of the same
year.

A store of this early period was that founded in 1824 by
Mr. Thomas G. Mackenzie at the northeast corner of
Baltimore and Gay streets. Associated with Mr. Mac-
kenzie in this venture were his father and two brothers,
all prominent physicians.

Thomas G. Mackenzie (1802-73) was the great moving
spirit in establishing the Maryland College of Pharmacy.
He was one of the organizers (1840) as well as one of the

"Dr. Allen is Associate Professor of Pharmacy,
University of Maryland School of Pharmacy.

I2

incorporators (1841) of the college. The lectures at the
new institution were given in his little office (back of drug
store) which was not larger than the hall of a home. Inthe
absence of the regular lecturers, Mackenzie gave occa-
sional talks to the students. The college functioned at this
location during the period 1840-44. The first class con-
sisted of six young men, but only three graduated in 1842
(Frederick A. Cochrane, Alpheus P. Sharp and William
S. Thompson).

In the spring of 1844 a committee from the Maryland
College of Pharmacy was appointed to endeavor to make
an arrangement with the Faculty of Physic of the Univer-
sity for a union of the two institutions.

On April 24, 1844, the Maryland College of Pharmacy
entered into an arrangement with the Faculty of Physic
of the University of Maryland whereby the lectures of
the College of Pharmacy were to be united with those of
the University so as to enable the students of medicine to
have the benefit of the lectures on pharmacy, in return
for which the students of pharmacy were to enjoy the
privilege of attending the lectures on chemistry by the
dean of the Faculty of Physic. The lectures on pharmacy
were delivered in the amphitheater of *‘Old Main’’ (now
Davidge Hall) located at Lombard and Greene Streets.
(Tradition has it that a large crowd of anxious Balti-
moreans viewed the spectacular firing on Fort McHenry
from the front entrance of this building, the events that
led to the writing of the Star Spangled Banner in 1814.)

At this time it was decided to elect a professor of
pharmacy to deliver the course of lectures. Dr. David
Stewart, who had in this year (1844) taken his degree in
medicine at the University was elected to the professor-
ship. The name of the chair of pharmacy thus created on
April 30, 1844 was the first in this country.

David Stewart (1813-99) was born in Port Penn, Dela-
ware. He arrived in Baltimore at the age of 18 to study
pharmacy and chemistry. David Stewart and his brother
James opened a drug store on Charles and Lexington
Streets (1839) and later at Hanover and Camden Streets
(1841). He became active in politics as well as civic
affairs and was a member of the City Council (1835-37),
School Commissioner (1836), State Senate (1840), In-
spector of Drugs (1850-53), State Agricultural Society
Chemist (1855-62) and at the same time professor of
Chemistry and Natural Philosophy at St. John’s College
in Annapolis.

The arrangement with the Faculty of Physic continued
in force until the year 1847, when the interest in the
college of pharmacy began to decline. For nine years the
college lay paralyzed and it was not until the year 1856

THE MARYLAND PHARMACIST

that interest in the institution was again revived. On
February 20, 1856 thirty-one apothecaries met at a hall
on the corner of Lexington and Eutaw Streets and helped
reorganize the college (it appears some classes may have
been held at this location).

In the fall of 1856, the College rented a room at the
corner of Calvert and Water Streets, fitted it with requis-
ite furniture and apparatus, and made all arrangements
for a resumption of an active college career, to which
there has been no interruption to the present time.

In 1858, the College was located in arented room of the
Maryland Medical and Chirurgical Building, 47 North
Calvert Street; and in 1868 at Number 12 West Baltimore
Street, a few doors west of the bridge crossing Jones
Falls (Fallsway today).

Meanwhile a large increase had taken place in the
number of students, and there had also been im-
provements and increases in the course of instruction, all
of which necessitated the providing of larger accommo-
dations. In accordance with these needs, in 1876 the
College purchased from the city a granite-front building
on Aisquith Street just north of Fayette Street, on the
east side, which was used as a public grammar school
(this building closely resembled the McKim school
house which stands today at the corner of Baltimore and
Aisquith Streets and is considered a gem of classic archi-
tecture).

In the Spring of 1886, further increase of accommoda-
tions was called for, and it was decided to erect a new
building upon the site of the one then occupied. An
architect was consulted, and a handsome structure
(frontage of sixty-seven feet and a depth of eighty-five
feet, and three stories high) was erected at a cost of
$35,000 and occupied during the latter part of the session
of 1886-87.

About 1898 the subject of a union of the College with
the University of Maryland became first bruited about as
a possibility. The formal mention of union was made by
the Dean of the Faculty of Physic, at the annual meeting
of the Medical Alumni Association in this year. He spoke
of proposed new Schools or Faculties, especially for the
purpose of the authorities of the University to seek affili-
ation with St. John’s College (Annapolis) and the Mary-
land College of Pharmacy. Also of considerable interest
is that back in 1882, the Faculty of Physic of the Univer-
sity of Maryland secured a charter from the Legislature
of the State of Maryland for a Department of Pharmacy
to be added to the School of Medicine.

The Legislature approved a supplementary Act on
March 21, 1882 authorizing the Regents of the University
to grant the degree of Doctor or Licentiate in Pharmacy
upon anyone who had served an apprenticeship of four
years with some competent pharmacist, and shall have
attended at least two full courses of lectures in the theory
and practice of pharmacy, and at least one full course in
qualitative analysis, and shall be at the time of receiving
the degree at least twenty years old.

Therefore, the Faculty of Physic made the first over-
tures, which were favorably received by the authorities
of the College, and the union was officially concluded on

DECEMBER, 1976

yf We Vi, A

ty | Lh vant ele, Sees Se, SE
This sketch of an early pharmacy school laboratory was taken from a
school catalogue, late 1800's.

July 7, 1904 and the Maryland College of Pharmacy
became the Department of Pharmacy of the University
of Maryland.

By this arrangement, the College assumed the same
relations to the University as the Department of Dentis-
try (established in 1882). Besides the greatly improved
location and the very desirable and stimulating influ-
ences of University life, the students were able to partic-
ipate in Medical Department lectures and laboratory in-
struction.

Accommodations were provided for this department
in the new Dental Building, erected in 1903-04, on the
east side of Greene Street, corner of Cider Alley. (This
building, although no longer devoted to its first use, has
been thoroughly overhauled many times, and is now
known as the Medical Technology Building, 31 South
Greene Street.)

Classes for the session 1904-05 opened in the building
on the University grounds, corner of Greene and Lom-
bard Streets. The office and pharmacy laboratories were
located in the new Dental Building. The chemistry and
microscopical laboratories were located in the Gray
Laboratory (erected about 1894 and it is still in active
operation today, situated behind the old medical building
now known as Davidge Hall). Lectures were held in
Gorgas Hall of the Dental Building and in the Amphi-
theatre of the old Medical Building (erected in 1813).

The change from an isolated School to a Department of
a University proved satisfactory and advantageous. The
University authorities felt that they had gained in this
College, with its fine traditions and its long and success-
ful career, a valuable ally and associate. The pharmacist,
with his systematic habits and business methods, and,
above all his common sense ideas — which are perhaps
not so common or conspicuous in our less practical pro-
fessions — was expected to bring to bear upon the staid
circles an influence and an example that would contri-
bute powerfully for their betterment.

In 1904, the Maryland College of Pharmacy (49 North
Aisquith Street) terminated its independent existence
and amalgamated with the School of Medicine. It was

(Continued on page 15)

13

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A History (Continued from page 13)

also the year of the Great Fire in the Monumental City.
The blaze started on Hopkins Place near Lombard
Street, the site today of the Federal Building in Hopkins
Plaza.

In 1907, the University was composed of only two
Colleges or Faculties — Law and Medicine — the latter
having attached to it subordinate departments of Dentis-
try and Pharmacy. At this time, someone stated, it was
an anomaly that the School of Pharmacy should be a
mere appendage to the School of Medicine — a change
which would occur if the Baltimore institution became a
great State University.

In 1920, the University of Maryland (Baltimore) was
merged with the Maryland State College (College Park)
and the combined institutions became the State Univer-
sity, the old name, University of Maryland, being con-
tinued. Following this merger, the Department of Phar-
macy became the School of Pharmacy of the new Uni-
versity of Maryland.

On April 22, 1922, the Schools of Dentistry and Phar-
macy received the deed for the property known as 27
South Greene Street, consisting of the old church and
parsonage buildings of the Emanuel Evangelical Church
(the present site of the Bressler Research Building). A
third floor, with a stairway leading to it, was built into the
body of the church building, and other necessary parti-
tions, etc. were put in place. The School of Pharmacy
moved into this building with its decorated church ceiling
and stained glass windows, early in November 1922. The
laboratories for chemistry and pharmacy were moved to
this building. Lectures were given on the first and second
floors and in Gorgas Hall of the Dental Building (some
laboratories in this building were also used). The upper
floors of the parsonage provided office space, as well as
storage and preparation rooms.

The School of Pharmacy session of 1925-26 opened
with a student body of two hundred and forty. This was
an increase of one hundred and forty-one students from
the session of 1921-22. Therefore, additional space was
needed not only to care for the students, but also for the
increase in the number of classes due to the establish-
ment of the three-year program.

Several alumni, disappointed in their efforts to secure
funds from the State of Maryland, formed the Greene
Realty Company and purchased the building at 6 and 8
South Greene Street for $32,000 (North hospital building
occupies this site at the present time).

The building was a four story factory-type structure
(often referred to in later years as the Box Factory by
many former students and faculty members), and after
some refurbishing, was occupied by the School of Phar-
macy on October 2, 1926. (This building was leased to the
University of Maryland, at a nominal rent by the alumni
group.)

New laboratories for dispensing pharmacy, physics
and zoology were equipped in this building. The offices,
reading room and library were established on the first
floor. However, the old Church and Dental buildings

DECEMBER, 1976

were still used for the remaining courses in the pharmacy
program.

The remarkable growth in matriculation continued and
additional space for the School became a necessity. In
order to give the overcrowded school some more space,
plans were formulated to erect a building on the north-
west corner of Lombard and Greene Streets. (Space in
this building was to be available also to the Dental
School.)

In 1927 the Legislature appropriated $422,000 for the
sole purpose of erecting a six-story building to be used by
the Schools of Pharmacy and Dentistry. In addition,
$55,000 was appropriated so that the two schools would
have adequate equipment in the way of apparatus and
other necessities such as furniture, and so forth. (At this
time it may be interesting to know that of the expenses
incurred in teaching pharmacy, $220 of that was contri-
buted by the annual fees from the students and only
$36.36 was appropriated by the State.)

Construction of this new modern unit of the University
to meet the needs of the Pharmaceutical and Dental
professions started in 1928 and was to be the beginning of
a modern educational plant for the Baltimore schools.

The fine new structure erected by the State at the
corner of Lombard and Greene Streets was dedicated on
Saturday, May 10th at the close of the Great 1930 Balti-
more Convention of the American Pharmaceutical As-
sociation. The formal dedication of the new building
marked a new epoch in pharmaceutical education. The
event emphasized the great changes which have come
about in the training of those entering the pharmaceutical
profession.

When the school moved into the new building, a new
department was instituted to give instruction in
physiological drug testing, pharmacology, toxicology
and therapeutics. The pioneer laboratory for **Drug
Testing’’ was so successful that it was used as a model
for similar installations throughout many other progress-
ive pharmacy colleges in the United States.

Since the new building also housed the School of Den-
tistry it soon became known as the Dental-Pharmacy
Building (now, after extensive and expensive renova-
tions knownas the Allied Health Professions Building).

In 1954, the University received an appropriation of
$575,000 for the initial phase of a new building for the
School of Pharmacy. Early in 1958 (January 6) the build-
ing opened its doors for classes. The new structure con-
sists of a basement and two floors and is located at 636
West Lombard Street.

This building was named after Dr. H. A. B. Dunning,
a distinguished alumnus of the School of Pharmacy, a
chemistry professor at the school for many years, and
former president of the Baltimore firm of Hynson, Wes-
cott and Dunning (first manufacturing company to pro-
duce mercurochrome).

The curriculum of the school, developed constantly
since 1841, in keeping with the trends in pharmaceutical
education has always provided competent professional
pharmacists with a good liberal and general education.

(Continued on page 20)

15

Francis S. Balassone Memorial Lecture

The first annual Francis S. Balassone Memorial Lec-
ture was held November 18, 1976 at the new freshman
medical school lecture hall on the Baltimore Campus of
the University of Maryland. Participating in the program
were (photo, left to right): Dr. George P. Hager, profes-
sor, School of Pharmacy, University of North Carolina;
Frank E. Kunkel, president, National Association of
Boards of Pharmacy; Mrs. Francis S. Balassone; Dr.
Robert K. Chalmers, associate dean, Purdue University
School of Pharmacy and member of the National Com-
mission on Pharmacy; and Dr. William J. Kinnard, Jr.,
dean, University of Maryland School of Pharmacy.

At the June 8, 1972, meeting of the Board of Trustees
of the Maryland Pharmaceutical Association, a commit-
tee was appointed by Bernard B. Lachman to investigate
a suitable commemoration to Francis S. Balassone. This
proposal had been presented by the Executive Director
Nathan I. Gruz, with the following committee approved:
H. Nelson Warfield, Simon Solomon and Norman J.
Levin. A joint committee with Alexander J. Ogrinz as
Chairman was formed with the Alumni Association. The
committee agreed to establish a fund for a memorial
lecture. An agreement was consummated between
MPhA, the Alumni Association and the Universjty of
Maryland School of Pharmacy whereby the University
would administer the fund and present the lecture. The
annual lecturer is chosen by a committee composed of
representatives of the three sponsoring groups.

FRANCIS S. BALASSONE
(1915-1972)

Francis S. Balassone was born in 1915 in Thomas,
West Virginia, the locale of his early education. After
graduating from high school, he worked in coal mines
near his home to aid his family and to earn income to
further his education that opened for him a pharmacy
career through which the profession of pharmacy is a
generous beneficiary.

In 1940, the University of Maryland School of Phar-
macy conferred on him the degree of Bachelor of Science
in Pharmacy. Thence extending his pharmacy experi-
ence he associated himself with two Baltimore drug
firms; first as chemist with the Standard Pharmaceutical
Corporation and next as general manager and vice presi-
dent with the Yager Drug Company. Francis Balassone
interrupted his career with the Yager firm to enlist as a

16

private in the United States Marine Corps for World War
I. In 1946 he was mustered out as a captain. During the
ensuing five years he resumed his association with the
Yager concern and also joined the teaching staff at his
Alma Mater.

Diversifying his career, Francis Balassone became
owner-manager of the Overlea Pharmacy in Baltimore,
1951-56. Subsequently, he served his state and his pro-
fession for nearly two decades, as Commissioner and
Secretary-Treasurer, Maryland Board of Pharmacy;
Chief, Division of Drug Control, Maryland State Health
Department and Acting Director, Bureau of Consumer
Health Protection.

Manifestations of his service, leadership and counsel
are indicated in the following: Delegate, United States
Pharmacopoeial Convention; Delegate, Office of Emer-
gency Planning, Executive Office of the President; Pres-
ident, National Association of Boards of Pharmacy;
Member, American Council on Pharmaceutical Educa-
tion; President, Central Atlantic States Association of
Food and Drug Officials of the United States; and
Chairman, Program Area Committee on Drugs, Ameri-
can Public Health Association.

Francis Balassone served as President of his Alumni
Association and also as Secretary and later as President
of the Baltimore Branch, American Pharmaceutical As-
sociation. During his tenure as Secretary of the Board of
Pharmacy he served as an ex-officio member of the ex-
ecutive bodies of the Maryland and Baltimore Metropoli-
tan Pharmaceutical Associations.

A leader in the development of state drug laws, he gave
impetus and guidance to recent Maryland legislation that
led to the passage of the Controlled Dangerous Sub-
stance Act which was used by Federal officials in con-
structing comparable Federal legislation and also to the
enactment of legislation known as the Mini Food and
Drug Law.

Under the leadership of Francis Balassone, Maryland
became the first state in the national to replace the tradi-
tional pharmacy internship with an academic profes-
sional experience program. Untiringly he collaborated
with the School of Pharmacy in the development and
evolvement of the new University of Maryland profes-
sional pharmacy program.

Awards conferred on Francis Balassone include the
School of Pharmacy Alumni Association Honored
Alumnus Award; the Merit Award, Central Atlantic
States Association of Food and Drug Officials of the
United States and the Nation’s highest award in the field
of drugs, food and cosmetic law, the Harvey W. Wiley
Award.

THE MARYLAND PHARMACIST

f

—

(left to right) Dr. George P. Hager, Frank E. Kunkel, Mrs. Francis S.
Balassone, Dr. Robert K. Chalmers, and Dr. William J. Kinnard, Jr.

TRIBUTE TO FRANK BALASSONE

George P. Hager, Ph.D.
Professor
School of Pharmacy
University of North Carolina

Thursday is Thanksgiving. Tonight we should give
thanks to our Creator for all persons — still living or now
departed — who have enriched our lives in so many
wonderful ways. It is in every way appropriate that I
preface in this way anything I shall say in memoriam of
Frank Balassone.

I know that Francis S. Balassone — Frank — would
join me tonight in a sincere acknowledgement of the
great debts he and I share owing to the pharmacists of
Maryland and the members of the MPhA — to the past
and present faculty and the alumni of the University of
Maryland’s School of Pharmacy — and to the beloved
members of our families, especially as they are repre-
sented here by Dolores and Margaret. I would fail utterly
tonight if I did not exercise to the fullest the great privi-
lege and honor of expressing in Frank’s behalf as well as
my own sincerest gratitude and most humble acknow-
ledgement to each and everyone present tonight and to
many more not present and, indeed, to many who, by
God’s grace, Frank has already joined and with whom
we, at our appointed times, will gather together in a new
communion that will endure forever.

In discussing with Al Ogrinz what would be appro-
priate to bring out on this occasion, I summed up my
impression of Frank in one word — ‘*Lincolnesque.”’ I
honestly don’t know whether my great admiration of
Frank stems from my admiration of this greatest of
Americans — Abraham Lincoln — or vice versa. I do
know that on my scale of values this ranks as absolutely
the highest praise I can express. I also know that lam not
alone in this high appraisal because Al subsequently
wrote me, ‘‘Personally I think your Lincolnesque ap-
proach is most appropriate (in talking about Frank).”’

As Lincoln — Frank had humble origins in the moun-

DECEMBER, 1976

tains of West Virginia — humble origins of which he was
fiercely proud.

As Lincoln — Frank performed a boot strap operation
in his career development starting with his role as a coal
miner and (part-time) barber in Thomas, West Virginia
and, through constant hard work, completing the B.S. in
Pharmacy curriculum at the School of Pharmacy in 1940.

As Lincoln — Frank had a great physical strength
which he never flaunted but which commanded a degree
of awesome respect even when he was initiated into the
Phi Delta Chi Fraternity — somehow the hazing was
tempered by realization of the size of his biceps. Charac-
teristically, he was later elected the Fraternity’s presi-
dent (or ‘‘Worthy Chief Counsellor’’). No one put into
practice more faithfully the Fraternity’s motto, *‘Al-
terium Alterius Auxilio Eget’’ (or each needs the help of
the other).

Frank, as Lincoln, served his country on the battle-
field. In World War II, during a four-year period, Frank
was a line officer in the Marines and he separated from
the Service with the rank of Captain.

As Lincoln — Frank was a superb statesman. A news
release at the time of his death published by the Ameri-
can Council on Pharmaceutical Education stated that
‘‘Balassone’s administrative background in public
health, drug and pharmacy (law) enforcement, along
with his judicious sense, his keen sense of fair play at the
council table — his friendly words of encouragement —
his eagerness to go beyond the call of duty — will make
him especially missed by his colleagues on the Council.
His warm, human traits will be treasured, and he will. . .
be an inspiration to us all for the rest of our lives.”’

Most of all — as Lincoln, Frank’s compassion for
others (his love for others that need not be requited to be
effective) was evident in many, many ways that can only
be exemplified by his unselfish concern for his friends
and by the tireless, devoted services he rendered in
helping them in times of need. I could give many per-
sonal, first-hand examples — as when Frank, alone,
among all my friends (even my sweetheart) saw me off on
the Shenandoah at Mount Royal Station after we had had
dinner together at the Deutsches Haus. I was leaving
home for the first time with a brand new B.S. in Phar-
macy degree to do graduate work in far off Colorado. I
needed the support of a friend then. Frank perceived my
need and acted accordingly.

Nor was this by any means an isolated instance. For
example, Mr. Nelson Warfield, on the occasion of the
dedication of the Francis S. Balassone Memorial Lec-
ture Hall in 1973 stated, ‘‘I recall how devoted (Frank)
was to Charles Austin, his very close friend and col-
league on the Board of Pharmacy — during his extended
illness — no burden was too great for him to carry — and
afterwards his assistance, advice, and counsel to Mrs.
Austin (was) of great help and comfort to the widow of
Charles Austin.’’ Note also a press release by the ACPE
which stated, ‘‘Frank will long be remembered by his
colleagues for his spirit of friendly helpfulness. Among
one of his last acts was that of befriending the widow of

(Continued on page 25)

17

Who Can Give Information
About Drugs in a Pharmacy?

Because of legislation initiated and drafted by the
Maryland Pharmaceutical Association only a pharmacist
or pharmacy extern can give information about drugs
and medicines and their therapeutic values, potential
side effects, and uses in the treatment and prevention of
diseases in Maryland. The bill was introduced by Dele-
gate Torrey Brown, a physician.

The law in effect recognizes that ina pharmacy there is
a specific health professional who is particularly quali-
fied by education and training to counsel a member of the
public who seeks information and guidance about
medication.

By contrast, in establishments other than a pharmacy,
the public is open to the dangerous practice of receiving
advice and recommendations about drug therapy from
clerks with no qualifications in providing health care. A
host of the ‘‘over-the-counter’’ remedies so readily
available in all kinds of outlets contain potent drugs,
many of which require a physician’s prescription in
larger doses. Pharmacists should take every opportunity
to educate the public that their health and often their very
lives are at stake. When people seek advice from un-
qualified employees of emporia, such as supermarkets
and variety stores, they are playing Russian roulette.
Only ina pharmacy Is there a person, as required by law,
who is competent to answer the public’s questions about
drugs factually and to direct people to the proper medical
practitioner as indicated.

In this issue of THE MARYLAND PHARMACIST you will
find a poster suitable for display in pharmacies. We
suggest that the poster be attached to a stiff cardboard or
a sign with an easel back. Place this important message in
a prominent place. Clerks in pharmacies can point to the
sign as a backup for patrons requesting information. It
will make referring them to the pharmacist on duty much
easier. Over a period of time it will go a long way in
getting the public to accept the fact that the pharmacy is
the place to get medication because
YOUR NEIGHBORHOOD PHARMACIST CAN

SAVE YOUR LIFE.

THE MARYLAND PHARMACIST

GENERAL ASSEMBLY OF MARYLAND

Official Address: State House, Annapolis, Maryland 21404 e Telephone 269-6800 from Baltimore Metropolitan Area
and 261-2300 from Washington Metropolitan Area for information during Session.

SENATE
DISTRICT 1—Garrett and Allegany Counties
Edward J. Mason (R) Rt. 2, Box 102-A, Cumberland, Md. 21502
DISTRICT 2—Washington and Allegany Counties
John P. Corderman (D) 82 W. Washington St., Hagerstown, Md. 21740

DISTRICT 3—Washington and Frederick Counties
Edward P. Thomas, Jr. (R) Terrace Office Bldg., 10 W. College
Terrace, Frederick, Md. 21701
DISTRICT 4—Frederick and Carroll Counties
Charles H. Smelser (D) 100 James SOB,110 College Ave,Annap,Md.21404
DISTRICT 5—Carroll, Harford and Baltimore Counties
C. A. Porter Hopkins (R) 404 James SOB, 110 College Ave.,Annap,Md.
21404
DISTRICT 6—Harford County
Arthur H. Helton, Jr. (D)
DISTRICT 7—Baltimore County
Donald P. Hutchinson (D)
DISTRICT 8—Baltimore County
Roy N. Staten (D) 100 JamesSOB,110 College Ave,Annap,Md.21404
DISTRICT 9—Baltimore County
Norman R. Stone, Jr. (D)
DISTRICT 10—Baltimore County
John J. Bishop, Jr. (R) 410 James Office Bldg.,110 College Ave.,
Annap., Md. 21404
DISTRICT 11—Baltimore County
Robert E. Stroble (R)

P. O. Box 696, Aberdeen, Md. 21001

418 Eastern Blvd., Baltimore, Md. 21221

6905 Dunmanway, Baltimore, Md. 21222

1839 Locust Ridge Rd., Lutherville—
Timonium, Md, 21093
DISTRICT 12—Baltimore County

Melvin A. Steinberg (D) 202 Loyola Federal Bldg,22 W.Penn.Ave.,

Towson, Md. 21204

DISTRICT 13—Baltimore County

John C, Coolahan (D) 1330 Sulphur Spring Rd., Baltimore, Md. 21227
DISTRICT 14—Howard and Montgomery Counties

James Clark, Jr. (D) Presidential Wing, James SOB, 110 College Ave.,

Annap.,Md. 21404
DISTRICT 15—Montgomery County

Laurence Levitan (D) 11426 Georgetown Dr., Potomac, Md, 20854
DISTRICT 16—Montgomery County
Howard A. Dennis (R) 14S. Adam St.,Rockville,Md. 20850

DISTRICT 17—Montgomery County
Charles W. Gilchrist (D) 305 James SOB, 110 College Ave.,Annap.,Md.21404
DISTRICT 18—Montgomery County

Margaret C. Schweinhaut 3601 Saul Rd., Kensington, Md. 20795
DISTRICT 19—Montgomery County

C. Lawrence Wiser (D) 12702 Littleton St., Silver Spring, Md. 20906
DISTRICT 20—Montgomery County
Victor L. Crawford (D) Suite 207, Maryland Center, 401 N.

Washington St., Rockville, Md. 20850
DISTRICT 21—Prince George's County
Arthur Dorman (D) 303 James SOB, 110 College Ave.,Annap.,Md. 21404

DISTRICT 22—Prince George’s County
Meyer M, Emanuel, Jr. (D) 1156 — 15th St., N.W., Suite 1100,
Washington, D.C. 20005
DISTRICT 23—Prince George’s County
Thomas Patrick O'Reilly (D) 209 James SOB, 110 College Ave.,Annap.,
Md. 21404
DISTRICT 24—Prince George’s County
Edward T. Conroy (D) 12432 Shawmont Lane, Bowie, Md. 20715

DISTRICT 25—Prince George’s County
5611 Landover Rd., Hyattsville, Md.
(D) 20785
DISTRICT 26—Prince George’s County
Steny H. Hoyer (D) State House, Annapolis, Md. 21404

DISTRICT 27—Prince George’s County
Peter A. Bozick (D) 204 James SOB, 110 College Ave.,Annap.,

Md. 21404
DISTRICT 28—Prince George’s and Charles Counties

Thomas V. Mike Miller, Jr. (D) P.O. Box 85, Clinton, Md. 20735
DISTRICT 29—Charles and St. Mary’s Counties
211 James SOB, 110 College Ave., Annap.,
Md. 21404

Tommie Broadwater, Jr.

James C. Simpson (D)

DISTRICT 30—Calvert and Anne Arundel Counties
Edward T. Hall (R) 407 James Senate Office Bldg, 110 College
Ave., Annap.,Md. 21401
DISTRICT 31—Anne Arundel County
Jerome F. Connell, Sr. (D) P.O. Box 610, Glen Burnie,Md. 21061
DISTRICT 32—Anne Arundel County

Alfred J. Lipin (D) 214James SOB, 110 College Ave.,Annap.,
Md. 21404
DISTRICT 33—Anne Arundel County
John A, Cade (R) 408 JamesSOB, 110 College Ave.,Annap.,
Md. 21404
DISTRICT 34—Queen Anne’s, Kent and Cecil Counties
Elroy G. Boyer (D) 107 Court St., Chestertown, Md. 21620

DISTRICT 35—Caroline, Dorchester, Talbot and Wicomico Counties
Frederick C, Malkus, Jr. (D) P.O. Box 316, Cambridge, Md. 21613
DISTRICT 36—Somerset, Wicomico and Worcester Counties
E. Homer White, Jr. (D) P.O. Box 342, Salisbury, Md. 21801
DISTRICT 37—Baltimore City

Harry J, McGuirk (D) 908 Frederick Rd., Baltimore, Md. 21228
DISTRICT 38—Baltimore City

Clarence M. Mitchell, I11 (D) 1239 Druid Hill Ave., Baltimore, Md. 21217
DISTRICT 39—Baltimore City

Julian L, Lapides (D) 809 Cathedral St., Baltimore, Md. 21201

DISTRICT 40—Baltimore City
Verda F. Welcome (D) 2101 Liberty Heights Ave.,
Baltimore, Md, 21217
DISTRICT 41—Baltimore City
Clarence W. Blount (D)
DISTRICT 42—Baltimore City

Rosalie Silber Abrams (D)

3307% Liberty Hgts.,Ave.,Balto.,Md. 21215

309 James SOB, 110 College Ave.,Annap.,

Md. 21404

DISTRICT 43—Baltimore City
J. Joseph Curran, Jr. (D)

DISTRICT 44—Baltimore City

206 Blaustein Bldg, Baltimore,Md. 21202

John Carroll Byrnes (D) 5221 Loch Raven Blvd., Baltimore, Md. 21239
DISTRICT 45—Baltimore City

Robert L. Douglass (D) 2503 E. Preston St., Baltimore, Md, 21213
DISTRICT 46—Baltimore City

Joseph S. Bonvegna (D) 419 S. Highland Ave., Baltimore, Md. 21224
DISTRICT 47—Baltimore City

Cornell N. Dypski (D) 6385S. Decker Ave., Baltimore, Md. 21224

HOUSE OF DELEGATES

DISiRIGaat
Sub-District 1A—Garrett County
DeCorsey E. Bolden (R) 3138S. Second St., Oakland, Md. 21550
Sub-District 1B—Allegany County
William B, Byrnes (D) P.O. Box 77, Eckhart Mines, Md. 21528
Thomas B. Cumiskey (D) 219 Schley St., Cumberland, Md, 21502
DISTRICT 2
Sub-District 2A—Allegany and Washington Counties
Casper R. Taylor, Jr. (D) 501 N. Mechanic St.,Cumberland,Md. 21502

Sub-District 2B—Washington County

Irwin F. Hoffman (D) 232 S. Potomac St., Hagerstown, Md. 21740

Sub-District 2C—Washington County

Donald F. Munson (R) 28 W. Church St., Hagerstown, Md. 21740
DISTRICT 3

Sub-District 3A—Washington County
Charles F. Wagaman, Jr. (R) 328. Magnolia Ave., Hagerstown, Md. 21740

Sub-District 3B—Frederick County

Julien P, Delphey (R) 222 Carroll Pkwy., Frederick, Md. 21701

C. Clifton Virts (D) 110N. Church St., Frederick, Md. 21701
DISTRICT 4

Sub-District 4A—Frederick County

Charles E. Smith (D) 403 Walnut St., Brunswick, Md. 21716

Sub-District 4B—Carroll County

Raymond E. Beck (R) 189 E. Main St.,Westminster,Md.21157

V. Lanny Harchenhorn (R) P.O. Box 542, 12 N. Court St.,Westminster,

Md.21157

DISTRICT 20—Montgomery County

EGATES
HOUSE OF DEL Sheila Hien (D) 1008 Broadmore Circle,Silver Spring,Md. 20904

Alexander Bolling Bell (D) 9618 Cottrell Terrace, Silver Spring, Md. 20903
Ida G. Ruben (D) 11 Schindler Court, Silver Spring, Md. 20903
é ee. DISTRICT 21—Prince George’s County
DISTRICT 5 : Kay G. Bienen (D) 12411 Radnor Lane, Laurel, Md. 20811
Sub-District 54—Harford County Pauline WeMenee (D) 3517 Marlbrough Way, College Park, Md, 20740
William H. Amoss (D) 2037 Pleasantville Rd., Fallston, Md. 21047 Andrew GO. Motherehead ib) 5107 Berwyn Rd.,College Park,Md. 20740
Sub-District 5B—Baltimore and Carroll Counties DISTRICT 22—Prince George’s County
Richard C. Matthews (R) 1309 Taylor Ave.,Hampstead,Md. 21074 John J. Garrity (D) 6401 New Hampshire Ave.,Hyattsville,Md. 20783
George A. Price (R) Stockton Farm, Phoenix, Md, 21131 Ann R. Hull (D) 1629 Drexel St., Takoma Park, Md. 20012
DISTRICT 6—Harford County Charles J. Sullivan, Jr. (D) 7100 Baltimore Ave., College Park,
George B. Adams, Jr. (D) 477 W. Bel Air Ave., Aberdeen, Md. 21001 Md. 20740
William H. Cox, Jr (D) 26 Office St., Bel Air, Md. 21014 :
one ' DISTRICT 23—Prince George’s Count
Catherine |. Riley (D) 20 Office St., Bel Air, Md. 21014 at Pra ely.

DISTRICT 7—Baltimore County
Peter J. Basilone (D) 11124 Sheradale Dr., Kingsville, Md. 21087

Dennis F. Rasmussen (D) 418 Eastern Blvd., Baltimore, Md. 21221

Michael H. Weir (D) 1707 Cape May Rd., Baltimore, Md, 21221
DISTRICT 8—Baltimore County

John S. Arnick (D) 2N. Dundalk Ave.,Balto., Md, 21222

Daniel J. Minnick, Jr. (D) 2421 Fairway, Balto.,Md. 21222

Patrick T. Welsh (D) 1930 Midland Rd.,Balto.,Md. 21222
DISTRICT 9—Baltimore County

John W. Seling (D) 8025 Phila. Rd., Balto.,Md. 21237

George E. Heffner (D) 7921 Belair Rd., Baltimore, Md. 21236

William Rush (D) 3307 Putty Hill Ave., Baltimore, Md. 21234
DISTRICT 10—Baltimore County

F, Vernon Boozer (R) 614 Bosley Ave., Towson, Md. 21204

Thomas B. Kernan (D) 1600 White Oak Rd., Baltimore, Md.

21234

William M. Linton (R) 312 LHOB, 6 Bladen St.,Annap.,Md. 21204

DISTRICT 11—Baltimore County

Bert Booth (R) 11231 Greenspring Ave., Lutherville-
Timonium, Md. 21093

Thomas W, Chamberlain, Sr, 307 Galway Rd., Lutherville-Timonium, Md,

(R) 21093
A. Wade Kach (R) 15 Berkshire Dr., Reisterstown,Md.21136
DISTRICT 12—Baltimore County
Arthur S, Alperstein (D) 4104 Balmoral Circle, Baltimore, Md, 21208
Theodore Levin (D} 626 Ralston Ave., Baltimore, Md. 21208
Howard J. Needle (D) 505 Alex Brown Bldg.,102 W. Penn. Ave.,

Towson,Md.21204
DISTRICT 13—Baltimore County

Timothy R, Hickman (D) 16B Montrose Manor Court, Baltimore, Md. 21227

J. Edward Malone
Louis P. Morsberger

(D) 5536 Oakland Rd., Baltimore, Md. 21227
(D) 612 Hilton Ave., Baltimore, Md. 21223

DISTRICT 14
Sub-District 14A—Montgomery County
Joel Chasnoff (D) 8728 Colesville Rd., Suite 1204, Silver Spring,
Md. 20910
Sub-District 14B—Howard County
Hugh Burgess (D) 8900 Frederick Rd.,P.O. Box 126,Ellicott
City,Md.21043

J. Hugh Nichols (D) P.O. Box 126, Ellicott City, Md. 21043

DISTRICT 15
Sub-District 15A—Montgomery County
Jerry H. Hyatt 9900 Main St., Damascus, Md. 20750
Sub-District 15B—Montgomery County
Arthur S. Drea, Jr. (D) 7809 Rydal Terrace, Gaithersburg,Md. 20855
Judith C, Toth (D) 6611 80th Place, Cabin John,Md.20034
DISTRICT 16—Montgomery County

Marilyn Goldwater (D) Suite 223A, LHOB.6 Bladen St.,Annap.,Md.21404
Nancy K, Kopp (D) Suite 223B, LHOB, 6 Bladen St.,Annap.,Md.21404

John X, Ward (D) 7801 Maple Ridge Rd., Bethesda, Md. 20014
DISTRICT 17—Montgomery County

Robert A. Jacques (D) 14S. AdamsSt.,P.O. Box 1488, Rockville,Md. 20850

Joseph E, Owens (D) 13619 Grenoble Dr.,Rockville,;Md. 20853

S. Frank Shore (D) 224 LHOB, 6 Bladen St.,Annap.,Md.21404
DISTRICT 18 Montgomery County

Charles A. Docter (D) Suite 801,1707 H St., N.W., Wash , D.C. 20006

Donald B, Robertson (D) 7003 Delaware St., Chevy Chase, Md. 20015

David L. Scull (DO) 8717 Susanna Lane, Chevy Chase, Md. 20015
DISTRICT 19—Montgomery County

Helen L. Koss (D0) 3416 Highview Court, Wheaton, Md, 20902

Lucille Maurer (D) 1023 Forest Glen Rd., Silver Spring, Md. 20901

Eugene J. Zander (0) 2013 Franwall Ave., Silver Spring, Md. 20902

Frank B, Pesci (D) 8311 Fremont Pl., New Carrollton, Md. 20784

Robert S. Redding (D) P.O. Box Z, Bowie, Md. 20715

Perry O. Wilkinson, Jr. (D) Suite 404, Presidential Bldg, 6525 Belcrest
Rd., Hyattsville, Md. 20782

DISTRICT 24—Prince George’s County

Gerard F, Devlin (D) P.O. Box Z, Bowie, Md. 20715
Leo E. Green (D) 3123 Belair Dr., Bowie, Md. 20715
David G. Ross (D) P.O. Box Z, Bowie, Md. 20715

DISTRICT 25—Prince George’s County
Nathaniel Exum (D) 5611 Landover Rd., Mitchell Bldg.,
Hyattsville, Md. 20705
Francis J. Santangelo, Sr.(D) 2nd Floor Mitchell Bldg, Cheverly,Md. 20784
Decatur W. Trotter (D) 3101 Polk Court, Glenarden, Md. 20801

DISTRICT 26—Prince George’s County
B. W. Mike Donovan

Craig S. Knoll
Lorraine M. Sheehan

(D) 7112 Mason St., Dist. Hghts.,Md. 20028
(D) 6108 Old Silver Hill Rd, Dist. Hgts, Md. 20028
(D) 6108 Old Silver Hill Rd, Dist. Hgts, Md, 20028
DISTRICT 27—Prince George’s County
Charles S, Blumenthal (D) Suite 302,6192 Oxon Hill Rd, Oxon Hill,
Md.20021
(D) Suite 302, LFL Bldg.,6192 OxonHill Rd >
Oxon Hill, Md. 20021
Frederick C, Rummage (Dp) 6300 Geo. Wash. Dr., Oxon Hill, Md.20031
DISTRICT 28—Prince George’s County
William R. McCaffrey (D) 12405 Lytton Ave., Brandywine, Md. 20613
Joseph F. Vallario, Jr. (D) 6007 St. Barnabas Rd. Oxon Hill, Md. 20021
John W. Wolfgang (D) 7906 Old Branch Ave., Clinton,Md. 20735

Frank J. Komenda

DISTRICT 29—Charles and St. Mary’s Counties
John Hanson Briscoe (D) State House, H-101,Annap.,Md. 21404

Royden P. Dyson (D) P.O. Box 5, Great Mills, Md. 20634
Michael J. Sprague (D) P.O. Box 314, Port Tobacco, Md. 20616
DISTRICT 30

Sub-District 30A—Calvert County

Thomas A. Rymer (D) Box 283, Prince Frederick, Md. 20678
Sub-District 30B—Anne Arundel County

Elmer F. Hagner, Jr. (D) 2511 Riva Rd., Annapolis, Md. 21401
Donald L, Rosenshine (D) 761-D Fairview Ave., Annapolis, Md. 21403

DISTRICT 31—Anne Arundel County
Harold L. Bachman (D) 213 HOB, 6 Bladen St.,Annap.,Md.21401
John J. Fallon (D) 14 Park Dr., Pasadena, Md. 21122
William J. Helms, Jr. (D) 293 McKinsey Rd., Severna Park, Md. 21146
DISTRICT 32—Anne Arundel County
Tyras S. Athey (D) 214 LHOB, 6 Bladen St., Annap, Md. 21404
Franklin A, Thomason (D) 302 Sycamore Rd., Linthicum Heights,
Md. 21090

Michael J, Wagner (D) 241 Wicklow Ave., Glen Burnie, Md, 21061

DISTRICT 33—Anne Arundel County

Patricia Aiken (D) 215 HOB, 6 Bladen St., Annapolis, Md.
21401

Robert R. Neall (R) P.O.Box 299, Davidsonville,Md. 21035

Elizabeth S. Smith (R) Rt.2—Box 96C Harbor Hills, Davidsonville,
Md. 21036

DISTRICT 34—Queen Anne's, Kent and Cecil Counties
Carter M. Hickman (D) Walnut Hill Farm, RED, Church Hill, Md. 21623
Richard D, Mackie
R. Clayton Mitchell, Jr. (D) 405 LHOB, 6 Bladen St.,Annap., Md. 21404

DISTRICT 35—Caroline, Dorchester, Talbot and Wicomico Counties
John R. Hargreaves (D) Route 2, Box 44-L, Pealiquor Landing Rd.,

Denton, Md. 21629
(D) P.O. Box 204, Easton, Md. 21601
(D) 1009 Radiance Dr., Cambridge, Md. 21613

William S, Horne
W. Henry Thomas

(D) Little Elk Farm, RD8, Box 203,Elkton,Md.21921

HOUSE OF DELEGATES

DISTRICT 36—Somerset, Wicomico and Worcester Counties
Russell O, Hickman (D) P.O.Box 230, Berlin,Md. 21811
Joseph J. Long (D) 730 S. Park Dr., Salisbury, Md. 21801
Robert Charles Biggy Long(D) Box 216, Westover, Md. 21871
DISTRICT 37—Baltimore City

R. Charles Avara (D) 1314 Light St.,Balto.,Md.21230

Madeline Rutkowski (D) 314 Washburn Ave., Baltimore, Md, 21225

Paul E. Weisengoff (D) 555 Brisbane Rd., Baltimore, Md. 21229
DISTRICT 38—Baltimore City

Isaiah Dixon, Jr, (D) 1607 W. North Ave., Baltimore, Md. 21217

Lena K. Lee (D) 330 N.Charles St.,Room 415,Balto.,Md.21201

Larry Young (D) 2322 Lauretta Ave., Baltimore, Md, 21223
DISTRICT 39—Baltimore City

Torrey C. Brown (D) 3941 Canterbury Rd., Baltimore, Md. 21218

Richard W. Emory, Jr. (D) 1100 Grace Bldg.,10 E. Balto. St.,Balto.,Md.

21202

William J. Madonna, Jr, (D) 211 W, 25th St., Baltimore, Md, 21211
DISTRICT 40—Baltimore City

Troy F. Brailey (D) 2405 Baker St., Baltimore, Md. 21216

Lloyal Randolph (D) 3400 Woodbrook Ave., Baltimore, Md. 21217

Kenneth L. Webster (D) 2836 Oakley Ave., Baltimore, Md. 21215
DISTRICT 41—Baltimore City

Walter R, Dean, Jr. (D) P.O.Box 11937, Balto.,Md. 21207

Pinkney A. Howell (D) 3301 Liberty Heights Ave., Baltimore, Md.21215

Arthur G. Murphy, Sr. (D) 2914 Edmondson Ave.,Balto.,Md.21225
DISTRICT 42—Baltimore City

Seat Vacant at Time of Printing

Benjamin L. Cardin (D) 211 St. Paul Place, Baltimore, Md. 21202

Steven V. Sklar (D) 119 Cross Keys Rd., Baltimore, Md, 21210
DISTRICT 43—Baltimore City

Andrew J. Burns (D) 1027 Munsey Bldg., Baltimore, Md. 21202

Henry R. Hergenroeder, Jr.(D) 4901 Harford Rd.,P.O. Box 3682, Balto.,Md
21214

Joseph William Lanasa (D) 3803 Evergreen Rd., Baltimore, Md. 21206
DISTRICT 44—Baltimore City

Gerald J. Curran (D) 2530 N. Charles St., Baltimore, Md. 21218

Dennis C. McCoy (D) Suite 2803, 222 St. Paul St.,Balto.,Md.21202

Frank C. Robey, Jr. (D) 1218 Havenwood Rd.,Balto.,Md. 21218
DISTRICT 45—Baltimore City

Joseph A. Chester, Sr. (D) 3027 E. Federal St., Baltimore, Md. 21213

John W. Douglass (D) 1535 E. North Ave.,Balto.,Md. 21213

Hattie N. Harrison (D) 2721 Mura St., Baltimore, Md. 21213

DISTRICT 46—Baltimore City
Edward J. Dabrowski, Jr. (D) 17 N. Highland Ave., Baltimore, Md, 21224

Charles J. Krysiak (D) 3307 Foster Ave., Balto.,Md. 21224

George J. Santoni (D) 3921 Lyndale Ave., Baltimore, Md. 21213
DISTRICT 47—Baltimore City

Raymond A. Dypski (D) 2824 Dillon St., Baltimore, Md. 21224

American Joe Miedusiewski(D) 625 S. Luzerne Ave., Baltimore, Md, 21224

Elmer Elmo Walters (D) 17 N. Curley St., Baltimore, Md, 21224

SENATE COMMITTEES

All located in James Senate Office Building
(Numbers indicate legislative district)

BUDGET AND TAAATION
Room 100 — 269-3542

ROY N. STATEN — 8 CLARENCE W. BLOUNT — 41
Chairman Vice-Chairman

Rosalie S. Abrams 42 Julian L. Lapides 39

Tommie Broadwater, Jr. 25 Laurence Levitan iss

Victor L. Crawford 20 ~=Alfred J. Lipin 32

Meyer M. Emanuel, Jr. 22 Edward J. Mason 1

Edward T. Hall 30 Charles H. Smelser 4

Staff — Gene Burner

CONSTITUTIONAL AND PUBLIC LAW
Room 400 — 269-3573
EDWARD T. CONROY — 24 NORMAN R. STONE, JR. — 9

Chairman Vice-Chairman
Elroy G. Boyer 34 Cornell N. Dypski 47
John A. Cade 33 Arthur H. Helton, Jr. 6
Howard A. Denis 16 Donald P. Hutchinson i

Staff — Richard Israel

ECONOMIC AFFAIRS
Room S-200 — 269-3296

HARRY J. McGUIRK —
Chairman

Joseph S. Bonvegna
Peter A. Bozick
John C. Coolahan
Arthur Dorman

37

46
27
13
21

F. C. MALKUS, JR. — 35
Vice-Chairman

Robert L. Douglass 45

Edward P. Thomas, Jr. 3

C. Lawrence Wiser 19

Staff — W. Porter Ellington

FINANCE

Room S-100 — 269-3747

JAMES CLARK, JR. — 14
Chairman

Charles W. Gilchrist
C. A. Porter Hopkins
Thos. Patrick O’Reilly
James C. Simpson

17

5
ee}
29

JOHN C. BYRNES — 44
Vice-Chairman

Robert E. Stroble 11
Verda F. Welcome 40
E. Homer White, Jr. 36

Staff — William Karson

JUDICIAL PROCEEDINGS
Room S-300 — 269-3251

J. JOS. CURRAN, JR. — 43
Chairman

John J. Bishop, Jr. 10

Jerome F. Connell, Sr. 31

John P. Corderman 2

MELVIN A. STEINBERG — 12
Vice-Chairman

Thos. V. Mike Miller, Jr. 28
Clarence M. Mitchell, Ill 38
Margaret C. Schweinhaut 18

Staff — Stuart G. Buppert

Hearing schedules, House and Senate seating plans, and
synopses of bills are available at the Legislative Information
Desk in the State House basement.

HOUSE OF DELEGATES COMMITTEES

All located in House of Delegates Office Building

(Numbers indicate legislative district)

APPROPRIATIONS
Room 131 — 269-3834

JOHN R. HARGREAVES — 35

Chairman

Charles S. Blumenthal
DeCoursey E. Bolden
Joseph A. Chester, Sr.
John W. Douglass
Marilyn Goldwater
George c. Heffner
Timothy R. Hickman
Robert Anthony Jacques
Nancy K. Kopp
Joseph W. Lanasa
William M. Linton

R. CHARLES AVARA — 37
Vice-Chairman

Richard D. Mackie 34
R. Clayton Mitchell, Jr. 34
Andrew O. Mothershead 21

Robert R. Neall 33
J. Hugh Nichols 14
Frank B. Pesci, Jr. 23
Dennis F. Rasmussen 7
Robert S. Redding 23
Frank C. Robey, Jr. 44
David L. Scull 18
Franklin A. Thomason 32

Staff — Odell Smith

CONSTITUTIONAL AND ADMINISTRATIVE LAW
Room 141 — 269-3228

CHARLES J. KRYSIAK — 46

Chairman

William H. Amoss
Harold L. Bachman
Bert Booth

William B. Byrnes
Thomas B. Cumiskey
Gerald J. Curran
Edward J. Dabrowski
B. W. Mike Donovan
Arthur S. Drea, Jr.
Richard W. Emory, Jr.
Leo E. Green

5
31
11

1

1
44
46
26
15
39
24

CHARLES J. SULLIVAN — 22
Vice-Chairman

Helen L. Koss 19
Lena K. Lee 38
Theodore Levin 1s
Pauline H. Menes Pil
Amer. Joe Miedusiewski 47
Donald B. Robertson 18
Dona!d L. Rosenshine 30
John W. Seling 9
Charles F. Wagaman, Jr. 3
Kenneth L. Webster 40

Staff — Don Eveleth

ECONOMIC MATTERS
Room 151 — 269-3471

JOHN W. WOLFGANG — 28

Chairman

Isaiah Dixon, Jr.
Charles A. Docter
Nathaniel Exum

.~ John J. Fallon

_Hattie N. Harris@gt
Frank J. Komenda
Joseph J. Long, Sr.
William J. Madonna, Jr.
Dennis C. McCoy
Louis P. Morsberger
Donald F. Munson

38
18
25
Sil
45
27
36
ao
44
is

2

J. EDWARD MALONE —

Vice-Chairman

Ida G. Ruben
William Rush

F. J. Santangelo, Sr.
George J. Santoni
Charles E. Smith
Elizabeth S. Smith
Casper R. Taylor, Jr.
Michael J. Wagner
John X. Ward

Patrick T. Welsh

Perry O. Wilkinson, Jr.

Staff — Thomas Steich

ENVIRONMENTAL MATTERS
Room 161 — 269-3965

JOHN S. ARNICK—8
Chairman

Patricia Aiken

Kay G. Bienen
Torrey C. Brown
Hugh Burgess

T. W. Chamberlain, Sr.
Julien P. De!lphey
Raymond A. Dypski
Royden P. Dyson
Sheila K. Hixson
Pinkney A. Howell
A. Wade Kach

33
Pail
ae
14
it

3
47
29
20
41
ut

IRWIN F. HOFFMAN

Vice-Chairman

Craig S. Knoll

Robert C. (Biggy) Long
William R. McCaffrey
Daniel J. Minnick, Jr.

Catherine |. Riley
S. Frank Shore
W. Henry Thomas
Judith C. Toth
Michael H. Weir
Larry Young

Staff — John Szymanski

JUDICIARY
Room 121 — 269-3224

JOSEPH E. OWENS —
Chairman

George B. Adams, Jr.
Arthur S. Alperstein

F. Vernon Boozer
Andrew J. Burns

Joel Chasnoff

Elmer FeeHagner, Jr.
V. Lanny Harchenhorn
William S. Horne
Jerry H. Hyatt
Richard C. Matthews

17

5

CARTER M. HICKMAN —

Vice-Chairman

Arthur G. Murphy, Sr.

Lloyal Randolph
David Gray Ross

Frederick C. Rummage
Madeleine Rutkowski

Thomas A. Rymer
Lorraine M. Sheehan
Steven V. Sklar

Joseph F. Vallario, Jr.

CeGlittonevlkes

Staff — Thomas C. Smith

WAYS AND MEANS
Room 111 — 269-3255
BENJAMIN L. CARDIN — 42

Chairman

Peter J. Basilone
Raymond E. Beck
Alexander B. Bell
Troy Brailey

William H. Cox, Jr.
Walter R. Dean, Jr.
Gerard F. Devlin
John J. Garrity
William J. Helms, Jr.
H. R. Hergenroeder, Jr.
Russell O. Hickman

36

TYRAS S. ATHEY — 32

Vice-Chairman

Ann R. Hull
Thomas B. Kernan
Lucille Maurer
Howard J. Needle
George A. Price
Michael J. Sprague
Cecatur W. Trotter
Elmer Elmo Walters
Paul E. Weisengoff
Eugene J. Zander

Staff — Hank Whaley

AN APPEAL FOR GRASS ROOTS HELP...

Write on your personal or business /etterhead, if possible,
and sign your name over your typed signature at the end of
your message,

Be sure your exact return address is on the letter, not just
the envelope. Envelopes sometimes get thrown away before
the letter is answered,

Identify your subject clearly. State the subject of the
legislation you're writing about, Give the House or Senate
bill number provided in the Annapolis Agenda.

State your reason for writing. Your own experience is
your best supporting evidence. Explain how the issue would
affect you, your business or profession—or what effect it
could have on the State or your community.

Avoid stereotyped phrases and sentences that give the
appearance of ‘‘form’”’ letters. They tend to identify your
message as part of an organized pressure campaign—and
produce little or no impact.

Be reasonable. Don’t ask for the impossible, Don’t
threaten. Don’t say, ‘I'll never vote for you unless you do
such and such,.”’ That won’t help your cause, but may
harm it.

Ask him to state his position in his reply. As his con-
stituent, you're entitled to know.

The timing of your letter is important. Begin to en-
courage approval or disapproval of a bill, or to recommend
that it be amended favorably, while it is in committee.
Take your cue from the Annapolis Agenda on this, Your
representatives usually can be more responsive to your
appeal at that time than after a bill has already been
approved by acommittee. Of course, this isn’t always
the case. Don’t give up because a bill is out of com-
mittee or through one house,

Thank him if he pleases you with his vote on an issue,
Everybody appreciates a complimentary letter and re-
members it. Legislators are no exception. But /f he votes
contrary to your position, don’t hesitate to /et him know.
He will remember that, too.

LEGISLATIVE DISTRICTS

The state is divided, on the basis of population, into 47
legislative districts, each of which elects one senator and
three delegates to the General Assembly. Some of the legis-
lative districts cross county lines, particularly in the rural
areas. Some legislative districts are sub-divided into three
single-member or one single-member and one two-member
delegate districts. (i.e. legislative districts 1, 2, 3, etc.)

In a legislative district containing more than two counties
(or parts thereof), and which is not sub-divided, no county
may have more than one delegate residing in it (i.e. legisla-
tive districts 34, 35, 36).

The Maryland
Pharmaceutical
Association

AS 44 PHARMAG: oT.

MARYLAND LAW requires that in a pharmacy only a PHARMACIST or
PHARMACY STUDENT under the supervision of a pharmacist may
provide information to the public concerning drugs and medicines
and their therapeutic values, potential side effects, and uses in the
treatment and prevention of diseases.

YOU can receive this assurance ONLY in a PHARMACY.
INSIST ON YOUR RIGHT TO PROFESSIONAL ADVICE.

A History (Continued from page 15)

Upon the successful completion of the program, grad-
uates have always been eligible to take state exami-
nations for licensure. For the scholastically able student,
various programs also trained men and women for many
positions in applied and research areas of pharmacy.

From the beginning the school has made many note-
worthy contributions to the advancement of pharmacy
and is one of the trail-blazers in this field. Alpheus
Phineas Sharp, one of the first graduates in the class of
1842, read the first scientific paper entitled ‘‘On the
Strength of Commercial Muriatic and Nitric Acids and
Alcohols’’ before the American Pharmaceutical Associ-
ation in New York City (1855). Merck, Sharp and Dohme
can trace its origin to the 1845 opening of his apothecary
shop in Baltimore.

In addition to the first separate professorship in the
theory and practice of pharmacy (1844), some other
‘‘firsts’’ include an obligatory course in analytical
chemistry (1872), a separate course in prescription com-
pounding (1900), a full-time Pharmacology Department
(1930), as well as professorships in these areas.

In 1870, the college called the first convention of
representatives of pharmacy schools to formulate uni-
form standards for the graduation of students. The con-
vention was held in Baltimore at the Maryland College of
Pharmacy and was the forerunner of the present Ameri-
can Association of Colleges of Pharmacy.

From the very beginning the school made many note-
worthy contributions to the advancement of pharmacy.
Today’s effective local laws for drug control are an out-
growth of efforts by early faculty members of the college.
Pharmacy laws initiated and fostered were the first law to
regulate the practice of pharmacy in Baltimore City
(1868) and the state-wide law (1902). In 1910, the legis-
lature provided for the appointment of a food and drug
commissioner and the first one was Charles Caspari, Jr.
(first dean of the College of Pharmacy).

The first meeting of the American Council on Pharma-
ceutical Education was held in Baltimore in 1932, follow-
ing efforts by the dean of the school to establish this first
accreditation body for schools of pharmacy. The post
office and principal business office address of the Coun-
cil was the School of Pharmacy (32 South Greene Street).
The council was incorporated August 12, 1939 under the
general laws of the State of Maryland. Dean Andrew G.
Dumez served on the Council as secretary-treasurer
(1932-48) and Past-Dean E. F. Kelly was president of the
organization (1932-44).

Beginning with the school session of 1928 graduate
courses were outlined and this inaugurated a graduate
work era of high grade which added much to the devel-
opment and prestige of the school. The first recipients of
the M.S. degree (1930) were John C. Bauer, William P.
Briggs and Frank J. Slama. On June 3, 1933 the first
Ph.D. degrees were awarded to John C. Bauer and Noel
E. Foss.

The Maryland College of Pharmacy and the University

20

of Maryland School of Pharmacy provided nine presi-
dents of the American Pharmaceutical Association from
1856-1940; two general secretaries of the Association,
one from 1894-1911 and the second from 1925-44; and
thirteen deans in schools of pharmacy.

The school revised its baccalaureate program in 1969
to include a six months professional experience program
within the final fifth year. These clinical-type clerkships
which take place in selected community and institutional
pharmacies throughout the state, are accepted by the
Maryland Board of Pharmacy in lieu of its traditional
internship requirements. Although the question of ade-
quate control of practical experience as a part of a well
balanced pharmaceutical education had been given
much study throughout the country for many years,
Maryland became the first state to eliminate the non-
structured internship. In a sense, the age-old concept of
an apprentice working under the personal supervision of
an experienced practitioner has been revived and
modernized.

Historically, pharmacy has been a clinically related
profession. In 1975, a six-year program (Pharm.D.) was
instituted to complement and enhance the baccalaureate
program. The primary function of the graduate of this
program is to perform a clinical therapeutic service to
patients and health professionals. The recipients of this
professional degree (Doctor of Pharmacy) will also be
capable of other roles including that of an educator in
pharmacy and other health-related programs.

The Maryland College of Pharmacy was a membership
institution and the officers were elected. There were
thirteen presidents of the college from the time of organi-
zation to several years after the amalgamation as a de-
partment of the Medical School of the University. With
the change in organization from that of an independent
institution to a unit of a University, the office of presi-
dent was abolished and a dean was appointed to assume
the responsibilities of the principal administrative offi-
cel:

MARYLAND COLLEGE OF PHARMACY

Presidents
1840-42 Thomas G. Mackenzie
1842-44 Benjamin Rush Roberts
1844-71 George W. Andrews
1871-72 J. Brown Baxley
1872-73 J. Faris Moore (1847)
1873-75 John F. Hancock (1860)
1875-88 Joseph Roberts
1888-90 Edwin Eareckson
1890-91 William S. Thompson (1842)
1891-97 Louis Dohme (1857)
1897-1906 Charles E. Dohme (1862)
1906-07 Henry A. Elliott
1907-08 Charles H. Ware (1886)

Dean of Faculty
1896-1904 Charles Caspari, Jr. (1869)

THE MARYLAND PHARMACIST

DEPARTMENT OF PHARMACY

(after merger with the University of Maryland in 1904)

Deans of Faculty

1904-17 Charles Caspari, Jr.*
1917-18 Daniel Base
1918-20 Evander F. Kelly (1902)

SCHOOL OF PHARMACY
(after consolidation of the University of Maryland with
the Maryland State College of Agriculture at College Park)

Deans
1920-26 Evander F. Kelly
1926-48 Andrew G. DuMez*
1948-49 B: Olive Cole (1913) **
1949-68 Noel E. Foss
1968- William J. Kinnard, Jr.

* Died in office
** Acting

(NOTE: Figure in parentheses following name indicates year of
graduation from Maryland College of Pharmacy or University of
Maryland.)

Brief Biographical Notes on Deans

Charles Caspari, Jr. (1850-1917) was born in Baltimore
and grew up in the atmosphere of his father’s pharmacy
on the west side of Gay Street north of Fayette Street. In
1865 he was an apprentice in an apothecary shop at Pratt
and Howard Streets. His preceptor was Louis Dohme,
one of the founders of the firm of Sharp and Dohme.
Upon the death of his father in 1870, he became the
proprietor of the drug store on Gay Street. He later
operated a store at Carey Street and Harlem Avenue and
also one at 800 West Baltimore Street, northwest corner
of Fremont Avenue (until 1891). His home address for
many years was 1129 Harlem Avenue, a typical large
Baltimore three-story rowhouse. In 1905 he was
awarded the honorary degree of Doctor of Pharmacy
(Pharm.D.) by the University of Maryland for his long
distinguished career and contributions to his profession.
The career of Charles Caspari was intimately connected
with the progress of modern pharmacy in the United
States. He was General Secretary of the American
Pharmaceutical Association (1894-1911), Food and Drug
Commissioner of Maryland (1910-17) and member of
three National Formulary Committees (1888-1906). He
was the author of five editions (1895-1916) of his own
textbook ‘‘Treatise on Pharmacy” and one of the editors
(1895-1916) of the ‘‘National Standard Dispensatory’’.

Daniel Base (1869-1926) was born in Baltimore and
obtained his elementary and secondary education in the
public schools. He graduated from the Baltimore City
College (a high school) in 1888. In the fall of the same
year he won a scholarship (in competitive examination)
and entered Johns Hopkins University, then located on
Howard and Centre Streets. He graduated in 1891 with
the degree of A.B. Again he won a scholarship and
continued his studies with chemistry as a major subject

DECEMBER, 1976

and received his Doctor of Philosophy Degree in 1895. In
the fall of the same year, he became a faculty member of
the Maryland College of Pharmacy and this association
continued until 1920. During his connection with this
institution, he contributed materially to the literature,
through his authorship of *‘Elements of Vegetable His-
tology’ (third edition appeared in 1912), and many re-
visions of *‘Simon’s Manual of Chemistry’? (eleventh
edition published in 1916). For many years the chemistry
publication had been a favorite work with the pharma-
cists of this country and regarded as being the last word
in the field. For several years he acted as secretary of the
faculty and also treasurer. For many years while associ-
ated with the College he resided at 329 North Schroeder
Street with his parents (this is within easy walking dis-
tance of the Baltimore Campus). In 1920 Dr. Base
stopped teaching and became the research chemist of the
firm of Hynson, Wescott and Dunning. During this time
he furthered the progress of the well known drug, Mer-
curochrome; prepared several interesting and impor-
tant organic antimony compounds; and was also respon-
sible for the compilation of the compound Benzyl
Mandelate.

Evander F. Kelly (1879-1944) was born in Carthage,
North Carolina. After working in several pharmacies
(including one in Green Cove Springs, Florida) he en-
rolled in the Maryland College of Pharmacy on Aisquith
Street and graduated with the Doctor of Pharmacy de-
gree in 1902 (with honors). Upon graduation he worked
on the staff of the Sharp and Dohme Manufacturing
Firm, southwest corner Howard and Pratt Streets,
where he advanced steadily to the position of superin-
tendent until 1911 when he resigned to devote his time to
the Pharmacy School. He was the first pharmacist lec-
turer at the Johns Hopkins School of Medicine (1917-44)
and also the first pharmacist to be a member of the
Maryland State Department of Health (1920-44). In 1926
he was elected General Secretary of the American
Pharmaceutical Association, a position which he occu-
pied until 1944. The headquarters offices of this Associa-
tion were located at 10 West Chase Street in Baltimore
for eight years (1926-34).

Due in large measure to his persistent prodding, Mary-
land enacted legislation requiring all practicing pharma-
cists to be college graduates. Among the many offices
and memberships that he held, Dr. Kelly was also Secre-
tary of the Maryland Pharmaceutical Association (1907-
42). In 1933 he was awarded the Remington Medal, the
highest award in the field of pharmacy, and the same year
he was given an honorary Doctor of Science Degree by
Temple University. He revfsed several times Caspari’s
popular book *‘Treatise on Pharmacy” and the last edi-
tion appeared in 1939. During a one-year period (1940-41)
he was also the first editor of the Practical Edition,
Journal of the American Pharmaceutical Association. In
1940 the American College of Apothecaries was or-
ganized and Dr. Kelly was a charter member. During the
early 1900's he resided in Baltimore at 330 North Charles
Street and 302 Edgevale Road, Roland Park. He then

(Continued on page 23)

21

The straighter
they talk,
the better

things get.

Pa
en.

Fred M. Eckel, R.Ph., Assoc Sam McConnell, Jr., R.Ph. John Spicer, R.Ph Al Rosica, R.Ph

Professor of Hospital Pharmacy Community Pharmacist Community Pharmacist Community Pharmacist

Chapel Hill, N.C Scottsdale, Arizona Fowler, Michigan Cherry Hill, New Jersey

Don F. Gould, R.Ph., Chairman Bill H. Hotaling III], R.Ph. Director Newell Hall, R.Ph., V.P. and Director Taylor H. Jobe, R.Ph

»f the Board, Gould Drug Company of Pharm. Services, Children’s Hosp. of Prof. Relations, Hook Drugs, Inc Community Pharmacist
Mt. Pleasant, Michigan National Medical Center,Wash., D.C Indianapolis, Indiana Gladewater, Texas

These days, any company that depends on
“yes” men for advice is riding for a fall.

At Upjohn, the views of pharmacy are im-
portant to us.

These ten leaders on our 1976 Pharmacy
Consultant Panel have provided us with an
invaluable service.

> wx They provide their views on a variety of mat-
0 I/D ES J ters — professional and operational — giving
Tom ©. Sharp, Jr, R.Ph. Lawrence C. Weaver, Ph.D., Dean US their candid Opinions. Kanrnaros, Michigan aaa

Ex f Tennessee Pharm. Assoc. College of Pharm.,Univ. of Minnesota
Nashville, Tennessee Minneapolis, Minnesota For this we are sincerely grateful
—— —E—————————————————E—————————E SS ’ .

THE MARYLAND PHARMACIST

A History (Continued from page 21)

lived for many years near Cockeysville, Maryland in a
large house called Montrose that once had been owned
by the Cockey family. In 1953 the Kelly Memorial Build-
ing (650 West Lombard Street) was dedicated in his
honor.

Andrew G. DuMez (1885-1948) was the son of a phar-
macist, receiving his motivation and practical training in
pharmacy from his father’s drug store. Born in Horican,
Wisconsin, he obtained his general education in the pub-
lic schools and then attended the University of Wiscon-
sin Where he graduated in pharmacy (Ph.G.) in 1904. The
following year he was appointed instructor in Pharma-
ceutical Chemistry at the University, a post he held until
1910. During this period he acquired the Bachelor of
Science and Master of Science Degrees. He then taught
at Pacific University (Oregon) and the next year at Okla-
homa Agricultural and Mechanical College. From 1912-
16 he served as Director of the School of Pharmacy at the
University of the Philippines. While in the Islands, he
first produced an ‘‘Emetine-Bismuth-lIodide’’ com-
pound for use in the treatment of amebic dysentery.
Upon returning to the United States, he accepted a
fellowship at the University of Wisconsin, earning a
Doctor of Philosophy Degree in 1917. At that time an
appointment to the U.S. Public Health Service took him
to Washington, D.C. Dr. DuMez left the federal service
in 1926 to accept his post at the School of Pharmacy.
While with the government and then the school he au-
thored many pharmaceutical publications and his editor-
ial contribution to pharmacy was a significant one. He
guided the school to a position which was the equal of or
the superior of any other pharmacy school in America.
Under his leadership graduate education was instituted
and encouraged. He sponsored the reorganization of the
Alumni Association and this greatly increased the inter-
est of the alumni and aroused a new spirit of fellowship
and cooperation.

B. Olive Cole (1883-1971) was born in Mount Carmel,
Baltimore County, Maryland. She graduated from
Franklin High School (Reisterstown, Maryland) in 1902
and then attended Baltimore Business College. She
began her career with the drug manufacturing firm of
Sharp and Dohme when it was located in Baltimore. Asa
result, Miss Cole entered the University of Maryland,
receiving the degree of Doctor of Pharmacy in 1913.
After graduation she was employed by a pharmaceutical
manufacturing company in Washington, D.C.

In 1920 Miss Cole joined the staff of the School of
Pharmacy serving as Secretary of the Faculty for more
than a quarter of a century. In addition, she taught
botany, materia medica, economics, pharmaceutical law
and administration courses. During her long professional
career, Dr. Cole was very active in pharmaceutical asso-
ciations and she wrote a number of articles on economics
and related areas, as well as on Maryland pharmacy

DECEMBER, 1976

history.

Dr. Cole was well known to hundreds of pharmacists
not only in Maryland but in other parts of the country.
Among her many unique ‘‘firsts-for-women”’ are: first
woman to receive a law degree from the University of
Maryland (1923), first woman dean ina pharmacy school
(1947), honorary president of the Maryland Pharmaceu-
tical Association (1951), honorary president of the
Alumni Association School of Pharmacy (1953), recip-
ient of the Honored Alumnus Award (1953), and the only
woman member of the Baltimore Veteran Druggists’
Association (1949),

In 1966 the B. Olive Cole Pharmacy Museum was
established in the Kelly Memorial Building adjoining the
present school of pharmacy. The American Institute of
the History of Pharmacy, in 1970, conferred its Certifi-
cate of Commendation upon Dr. Cole for her activity
over the years in fostering attention to the profession’s
history and dedicated service to humanistic values in
Pharmacy.

Noel E. Foss (1906- ) was born at Henry, South
Dakota. He received his undergraduate training at the
South Dakota State College where he was awarded the
Pharmaceutical Chemist (Ph.C.) and Bachelor of Sci-
ence in Pharmacy (B.S. in Pharm.) degrees in 1929.
Following his employment in retail pharmacy at Hot
Springs, South Dakota he was awarded the first H. A. B.
Dunning research fellowship offered by the School of
Pharmacy, University of Maryland and received the
Master of Science (1932) and Doctor of Philosophy
(1933) degrees.

From 1934-37, Dr. Foss was professor of Pharmacy at
Duquesne University (Pittsburgh). He obtained a wealth
of industrial experience while employed (1937-42) at
Burroughs, Wellcome and Company (New York). He
served his country from 1942-46 in the U.S. Army Medi-
cal Purchasing Office, St. Louis, Missouri and New
York City; and was also on special assignment to France
and Germany. At war’s end (1946-47) he was Technical
Director of the Pharmaceutical Department Calco Chem-
ical Division of American Cyanamid Company (New
Jersey). He was appointed Assistant Dean of the Univer-
sity of Illinois College of Pharmacy (1947-49).

Dr. Foss authored, or co-authored, more than
twenty-five publications relating to numerous pharma-
ceutical subjects and his professional activities included
state and national organizations.

Dr. Foss strove conscientiously to advance pharmacy
and during his tenure as Dean, a new building (Dunning
Hall) was erected for the school, a number of young and
dynamic faculty members were added to the staff, the
curriculum was revamped and revised along true educa-
tional lines, first refresher course for retail pharmacists
(continuing education), and the model pharmacy was
established in Dunning Hall.

In 1970, the Board of Regents, acting upon the
recommendations of the faculty, awarded him the title of
Dean Emeritus.

(Continued on page 30)

Think of er tik

man as 18,0
of

The next time your Robins Repre-
sentative comes around, remember: he’s
one very important reason for those eight-
een million bottles of Robitussin you sell
every year.

Because we think the most respon-
sible way of promoting our Robitussin
products is directly to the doctor. And the
product information your Robins man
passes along to that busy doctor plays a big

part in his recommendations and _ pre-
scriptions.

So the result of all the miles your
Robins man travels and all the hours he
waits isn’t just better health for millions
of people. It’s also better business for you.

And for us. All those bottles of Robi-
tussin add up to a whopping eighteen
percent of the cough preparations you sell.

< j

000 bottles

#8 ES eHgS

Robins products are number one in the
total ethical cough and cold market. And
we're one of the top five leaders in new
prescriptions.

Think about that when you see your
Robins man. After all, when he’s out there
working for us, he’s also out there working
for you.

He's your Robins man.

A-H[OBI NS

Think of us as your partner
business of better health.

in the good

AH. Robins Company, Richmond, Virginia 23220

THE MARYLAND PHARMACIST

A Tribute (Continued from page 17)

the late Dr. Andrew G. DuMez for whom he had great
admiration and respect.’’ Is this anything short of Lin-
colnesque? Listen for a moment to an excerpt of
Lincoln’s Second Inaugural address, ‘‘With malice to-
ward none; with charity for all; with firmness in the right,
as God gives us to see the right, let us strive on to finish
the work we are in; to bind up the nation’s wounds; to
care for him who shall have borne the battle, and for his
widow, and his orphan — to do all which may achieve a
just and lasting peace among ourselves, and with all
nations.’

Robert Frost must have had someone like Frank in
mind — a person who constantly subordinated his own
convenience and pleasures in order to minister to the
needs of others — when he wrote:

‘The woods are lovely, dark, and deep;

But I have promises to keep
And miles to go before I sleep.
And miles to go before I sleep.”’

After graduating and before going into the Service,
Frank worked as an analytical chemist at Standard
Pharmaceutical Corporation and, for a while, as general
manager of Yager Drug Company. After the War, he
resumed his work at Yager’s and his warm association
with Mr. Edward E. Murray, eventually being promoted
to the vice presidency of the company. Later, for a
five-year period, Frank owned and operated a commun-
ity pharmacy in Overlea. In 1955, he was appointed Chief
of the Division of Drug Control, Maryland State De-
partment of Health — following the footsteps of two
outstanding predecessors, Robert L. Swain and L. M.
Kantner. During this period, Frank also served as Com-
missioner and Secretary-Treasurer of the Maryland
Board of Pharmacy and later as Acting Director of Con-
sumer Health Protection.

Frank’s outstanding record in drug control was
recognized in 1965-66 when he served as president of the
National Association of Boards of Pharmacy. Well-
deserved recognition also came to Frank in the form of
awards: the School of Pharmacy Honored Alumnus
Award — the Merit Award from the Central Atlantic
States Association of Food and Drug Officials of the
United States — and, in 1971, the nation’s highest award
for food, drug, and cosmetic law enforcement officers,
the Harvey W. Wiley Award.

Truly Frank has left a rich heritage to his many friends
and associates in his example of a life of service to
others. However, not his example alone, but also his
precept is a legacy of which each of us is challenged to be
a faithful steward. He said, **‘Let us then each renew our
dedication, let us each contribute what we can to better
our profession and to serve the public welfare to the best
of our ability, let us each give a true gift, a portion of
ourself, to better the future of mankind.”

The addresses of Frank E. Kunkel and Dr. Robert K. Chalmers will
appear in subsequent issues of THE MARYLAND PHARMACIST

DECEMBER, 1976

MUWF

Baltimore Metropolitan
Pharmaceutical Association

The Baltimore Metropolitan Pharmaceutical Associa-
tion held its annual meeting at the New Howard Hall
addition of the University of Maryland Baltimore Cam-
pus on November 18 following the First Balassone
Memorial Lecture.

The feature was the election of officers with Stanley J.
Yaffe, President-Elect assuming office as president for
1977. Elected to the Executive Committee for 2 year
terms were: Joseph W. Loetell, Marvin L. Oed and Mrs.
Oscar (Norma) Schapiro. Re-elected was Richard E.
Myers and completing terms are: Elwin H. Alpern,
Barry L. Bloom, James B. Culp, Jr. and Bernard N.
White.

Officers’ reports were presented by outgoing presi-
dent Lubman, Treasurer Spigelmire and Executive Di-
rector Nathan I. Gruz. The Membership Committee re-
port was given by Elwin Alpern who discussed plans for
membership enrollment in the coming year. The 1976
total membership was 10 more than 1975. Milton Sappe,
Chairman of the Banquet, reported on the affair. Marvin
Friedman, Chairman of the Prescription Insurance Pro-
grams presented an update on Medicaid, status of cost
survey and HMO problems.

Following the presentation of a slate by the Nominat-
ing Committee there being no further nominations, the
slate was adopted unanimously. Charles E. Spigelmire
installed the officers and executive committee.

Victor Morgenroth suggested that a resolution be pre-
sented by BMPA to the MPhA House of Delegates re-
garding relations of Environmental Health Administra-
tion and its administrator to the Board of Pharmacy.
Executive Director Gruz requested agenda items to be
suggested to BMPA for presentation to the MPhA House
of Delegates. He also requested that information regard-
ing conduct of inspections by Division of Drug Control
be reported to the office.

Loewy President Chairs
National Committee

Philip Levin, president of Loewy Drug Company
(Spectro), chaired the meeting of the Government Rela-
tions Committee for the National Wholesale Druggists’
Association. His committee met to discuss MAC,
National Health Insurance, FDA recall policies and pro-
cedures, and current product liability problems.

Mr. Levin is an affiliate member of the Maryland
Pharmaceutical Association.

(Continued on page 27)

Big enough to
service you....

Small enough to
know you

Today...as always
...IN quality,
experience, reliability,
Paramount means
personal service and
personal contact!

2920 Greenmount Avenue
Baltimore, Maryland 21218

Phone: Baltimore — 366-1155; Washington (local call) 484-4050
ERE 2S)

THE MARYLAND PHARMACIST

News (Continued from page 25)

Standard Prescription Form
Effective April Ist for Claims

As aresult of extensive research and development bya
Claim Form Subcommittee of the Drug Ad Hoc Commit-
tee, third party groups will begin use of a Standard Pres-
cription Drug Claim Form on April 1, 1977. The follow-
ing organizations have committed themselves to use the
form: PCS, PAID Prescriptions, Aetna, Metropolitan
and Travelers Insurance Companies. The form has been
endorsed by the Blue Cross Association of America and
will carry the symbol of the Health Insurance Associa-
tion of America (HIAA), signifying that the form has
been approved by the nation’s health insurance industry.
The required volume for the first year’s use of the form
has been estimated at 100 million. The forms will be
printed by Moore Business Forms Company and distrib-
uted to the nation’s drug wholesalers. Pharmacies will
obtain the forms from the wholesalers and will, in turn,
be paid for each form submitted by the appropriate
administrator, underwriter or sponsor of the program.
This long-awaited development is a significent step for-
ward in easing the burden of third-party claims process-
ing for the nation’s pharmacists.

NDC Rejections

In order to avoid rejections, please pick up the NDC
number exactly as it is written on the labels — do not rely
on NDC numbers printed in trade publications or use the
product numbers. Example: We recently noted the NDC
number for Slow-K was incorrectly printed in a trade
publication. The correct number is: 0083-0165-30.

PCS has requested that drug codes for compounded
prescriptions be omitted. Just list the ingredients on the
bottom line of the claim form in the box marked ‘‘Medi-
cation Name and Dosage Form”’ and leave the drug code
box blank.

CPS

Complimentary Prescription Service (CPS) has grown
tremendously since its inception in 1971. The concept,
developed as an alternative to physical samples, has
already been endorsed by 14 state pharmaceutical asso-
ciations, including MPhA, and continues to add par-
ticipating manufacturers and new products to their pro-
grams. The program reimburses the pharmacist his *“‘us-
ual and customary’’ amount for handling the distribution
of companies’ samples.

Pharmacists should express their views about the CPS
program to manufacturers and physicians by using com-
plimentary prescriptions.

(Continued on page 31)

WHAT IS ASTRO????

‘“OUR’”’ aie “WOUR’”’
ASTRO PROGRAM

A SUCCESS!!!!

FOR DETAILS CONTACT TOM SOMERS
301-467-2780

THE CALVERT DRUG COMPANY

901 Curtain Avenue
Baltimore, Maryland 21218

DECEMBER, 1976

New MPhA Members

The following is a list of new members of the Maryland
Pharmaceutical Association approved by the Board of
Trustees for the period from March 1976 to January 1977.

Lawrence Appel, Reandallstown
Deborah Arbogast, Adelphi
Pablo Atienza, Baltimore
Douglas Behrens, Glen Burnie
Abrian Bloom, Baltimore

Anne Boucher, Beltsville
Michael Burns, Laurel

Donald Ceccorulli, Frederick
Peter Chan, Silver Spring

David Chin, Baltimore

Lily Chua, Baltimore

Paul Cuzmanes, Reisterstown
Anne Eggers, Silver Spring
Vincent Fabiano, Glen Burnie
CDR Raymond Farkas, Rockville
Richard Fry, Alexandria, Va.
Frank Gammino, Mitchellville
Mark Golibart, Baltimore

nancy Gehauf, Cumberland
Abraham Glaeser, Baltimore
Aaron Grebow, Baltimore
Richard Greenberg, Baltimore
John Gregory, Rockville

George Groleau, Baltimore
Gary Haas, Keedysville

Mark Hawes, Frederick

Linda Houchin, Laurel

Dennis Igoe, Ellicott City

Paul Jarosinski, Watertown, Mass.
Myles Kaye, Silver Spring
Miriam Kaminitz, Baltimore
Michael Kesselman, Baltimore
Barbara Kirby, Hyattsville
Michael Labat, Maplewood, New Jersey
Nicole Lembke, Bowie

Irving Levy, Annapolis

Louis Lindenbaum, Linthicum
Judy Lyon, Bel Air

Francis McGinity Jr., Baltimore
John Moss, Baltimore

Thomas Murray, Baltimore
Roger Musser, Baltimore

Irene Nowosiwsky, Rockville
Glenda Ownes, Beltsville
Pamela Perza, Gaithersburg
Christos Petropoulos, Baltimore
John Rapier, Gaithersburg
Sanford Rosenbloom, Baltimore
Christopher Shawyer, New Orleans
Leslie Silverberg, Baltimore
Rose Smith, Cumberland
Adesino Sobanjo, Baltimore
Carol Solt, Frederick

Theodore Sophocleus, Linthicum
Irving Sowbel, Stevensville
Richard Swenton, Morningside
Sandra Turney, Bowie

L. Suzann Wheatley, Olney
Kenneth Whittemore, Laurel
Paula Wolfe, Baltimore

28

Simon Solomon
Pharmacy Economics Seminar

The Maryland Pharmaceutical Association conducted
its annual Simon Solomon Pharmacy Economics Semi-
nar on November 4 at the Quality Inn, Towson. Chair-
man Kenneth S. Sumida opened the day’s proceedings,
and Melvin N. Rubin, President of MPhA brought
greeings to those attending the seminar which focused on
the entrepreneur in pharmacy and the various factors
involved in opening, buying or expanding one’s phar-
macy. Joining the chairman in developing this theme was
keynote speaker Paul A. Pumpian, President of
Ketchum Marketing Services, Inc. Mr. Pumpian em-
phasized the need for sound business principles as the
cornerstone of survival for independent pharmacy. A
panel discussion followed which reinforced Mr. Pum-
pian’s thoughts by reviewing the purchasing alternatives
available to the pharmacy owner in the Baltimore-Wash-
ington area. The panel consisted of Joseph J. Hugg,
Retailer Services Representative, Henry B. Gilpin &
Company; Harrison L. Leach, Vice President for Re-
tailer Services, Care Drug Centers; Kenneth L. Mills,
Sales Manager, Calvert Drug Company; Allan Posner,
Sales Manager, Loewy Drug Company; Paul A. Pum-
pian; and Stanley J. Yaffe, President, AID Drug Stores.

The luncheon session was presided over by Nathan I.
Gruz, Executive Director of MPhA, who introduced the
luncheon speaker, William E. Woods, newly elected
Executive Director of NARD. This position of national
prominence gave added significance to his topic: ‘‘The
National Scene — What’s the Outlook for Independent
Pharmacy?’’

The afternoon session highlighted two speakers whose
concern was in helping the pharmacist obtain the maxi-
mum return on his investment. Ted Gladson, Design and
Merchandising Consultant to NARD and President of PE
Systems, Chicago, gave a slide presentation with con-
siderable documentation on ways to increase your
front-end profits. Robert H. Allen, President of Medical
Equipment Unlimited, Division of Spectro, discussed
the financial and professional reasons for establishing or
expanding a Medical Support and Equipment Depart-
ment.

Sustaining Members
Maryland Pharmaceutical
Association

BORDEN-HENDLER COMPANY
CALVERT DRUG COMPANY
F. A. DAVIS & SONS
H. B. GILPIN COMPANY
LOEWY DRUG COMPANY
MARYLAND NEWS COMPANY
MILLER DRUG SUNDRY COMPANY

THE MARYLAND PHARMACIST

Luncheon speaker
William E. Woods,
Executive Director,
NARD, SCC ond from
left with (right to left)
Seminar Chairman
Kenneth Sumida, MPhA
President Melvin Rubin
and Executive Director
Nathan Gruz.

Keynote speaker Paul
Pumpian, third from
right; with (left to right)
panelists Kenneth Mills,
Richard Parker, Stanley
Yaffe, Allan Posner,
Kenneth Sumida,
Harrison Leach and
Joseph Hugg.

Seminar speakers
Robert H. Allen (left)
and Ted Gladson (right)
with Chairman Kenneth
Sumida.

A History (Continued from page 23)

William J. Kinnard, Jr. (1932- ) was born in Wil-
mington, Delaware and earned his Bachelor of Science in
Pharmacy (1953) and Master of Science (1955) degrees
from the University of Pittsburgh and the Doctor of
Philosophy (1957) degree from Purdue University. His
graduate degrees were in pharmacology and his research
interests, as reflected in many scientific publications,
center on the neurophysiological, behavioral and cardio-
vascular aspects of pharmacology.

Dr. Kinnard, in the tradition of Maryland deans, led
the school to national prominence again with a restruc-
tured patient oriented undergraduate curriculum, and
the Professional Experience Program and a Pharm.D.
program. At the present time Dr. Kinnard is also dean
of the Baltimore Campus Graduate School, chairman
of the United States Pharmacopeia Board of Trustees
and President of the American Association of Colleges
of Pharmacy. Because of his direct interest and very
active role, the following are in existence today in the
School of Pharmacy: Maryland Poison Information
Center, Drug Abuse and Consumer Education Program.

APhA Announces 1979
Convention Site

Anaheim, California has been selected as the host city
for the 1979 Annual Meeting of the American Pharma-
ceutical Association at a recent meeting of the Associ-
ation’s Board of Trustees.

The meeting will be held April 21-26, 1979, with exhi-
bits to be held in the Anaheim Convention Center, April
22-25. Official hotels include the Disneyland,
Sheraton-Anaheim, Inn at the Park, Quality Inn, Grand,
Holiday Inn, Hyatt House, Howard Johnson and the
Jolly Roger.

The 126th Annual Meeting will mark the first time that
the Association has met in this Southern California city.
Although best known for the Magic Kingdom of Disney-
land, other attractions in this sunny, family vacationland
include the Mission of San Juan Capistrano and Knott’s
Berry Farm.

As previously announced, the 1978 APhA Annual
Meeting will be held May 13-18, in Montreal, Canada,
while the upcoming 1977 Annual Meeting will be held in
the ‘“‘Big Apple’? — New York City — May 14-19.

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FOTO DATE: AUG., 1975

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30

THE MARYLAND PHARMACIST

News (Continued from page 27)

Prince Georges-
Montgomery County
Pharmaceutical Association

The Prince Georges-Montgomery County Pharmaceu-
tical Association Meeting was held November 23, 1976 at
the Sheraton-Silver Spring Motor Inn Hotel. President
Henry W. Theis, Jr. presided. The featured speaker was
Delbert D. Konnor, Pharm. M.S., Staff Coordinator for
Voluntary Compliance, Drug Enforcement Administra-
tion. Mr. Konnor described the efforts made by his
agency to develop better lines of communication with
practicing pharmacists. To effect this policy, he cited
numerous committees and departments headed by
pharmacists who can better understand the needs and
problems of the profession. A spirited question and an-
swer period followed.

Immediately following, Nathan Gruz, Executive Di-
rector of MPhA, discussed the recent change in proce-
dure by the Maryland State Department of Health and
Mental Hygiene’s Division of Drug Control in its inspec-
tion of pharmacies.

MPhA Radio Program
Establishes Record

On November 22, 1959, WCAO radio introduced to its
listening audience the Maryland Pharmaceutical Associ-
ation public service program, ‘‘Your Best Neighbor’’,
with its host, Charles Spigelmire. Both the series and
host have survived the test of time, as ‘‘Your Best
Neighbor’’ is the longest weekly continuous public ser-
vice broadcast on WCAO. The show is presently aired
on Sunday, 5:00 a.m. on WCAO AM (60.0 on the dial)
and Wednesday, 3:30 p.m. on WCAO FM (92.0 on the
dial).

Spanning the eighteen years and over 850 broadcasts,
this program has promoted the pharmacist as a profes-
sional upon whom the general public can depend for its
health care needs. In addition, many programs have
featured special guests who relate timely information in
their area of expertise, e.g. Diabetes Detection Week,
Poison Prevention Week, Drug Abuse Committees and
others.

Toronto Group Visits
School of Pharmacy

A delegation from the College of Pharmacy in Toronto
recently reviewed and observed the Professional Expe-
rience Program at the University of Maryland School of
Pharmacy. The program, initiated in 1969, is the proto-
type in the nation for incorporating student externship
within the structured five-year curriculum. The visitors
from Toronto, including the dean of the college, a senior
student, and state board members, hope to implement a
similar program at their institution in the near future.

(Continued on page 32)

DECEMBER, 1976

olboiltuaries

SAUL REITER

Saul Reiter, 62, who had operated several pharmacies
in the suburban Washington area spanning 35 years, died
December 9. He had been a member of Prince
Georges-Montgomery County and Maryland Pharma-
ceutical Associations.

Mr. Reiter was born in Brooklyn, New York and at-
tended Columbia University School of Pharmacy. He
came to the Washington area in 1934, and operated
Alaska Pharmacy and Brightwood Pharmacy in Wash-
ington until ten years ago. Since 1966 he had owned
Hospital Pharmacy Center in the University Nursing
Home in Silver Spring.

Mr. Reiter was a member of the Washington Bridge
Club and a life master in the American Bridge League.

A 32nd degree Mason, he belonged to the Cornerstone
Lodge and Almas Temple, and was a charter member of
the Temple Shalom Synagogue.

He is survived by his wife Jean, his son Robert, his
daughter Marcia MacLeod, a brother and three sisters.

SOLOMON MILLER

Solomon David Miller, who had owned several phar-
macies in the Baltimore area, died December 9, 1976 at
the age of 60. Mr. Miller, a native of New York, was a
member of the 1937 graduating class of the University of
Maryland School of Pharmacy.

PHILIP C. BAER

Philip C. Baer, 96, a partner for many years in the drug
firm of Morgan and Millard, and former proprietor of
several pharmacies in Baltimore, died December 31,
1976.

CHANGE OF ADDRESS

When you move—

Please inform this office four weeks in advance to avoid
undelivered issues.

"The Maryland Pharmacist'’ is not forwarded by the Post
Office when you move.

To insure delivery of "The Maryland Pharmacist’ and all

mail, kindly notify the office when you plan to move
and state the effective date. APhA members—please in-
clude APhA number.

Thank you for your cooperation.

Nathan |. Gruz, Editor
Maryland Pharmacist

650 West Lombard Street
Baltimore, Maryland 2120)

News (Continued from page 31)

Gilpin Announces
New Appointments

The Henry B. Gilpin Company announced the ap-
pointments of three new members to its wholesale drug
operation. Louis Gatto has assumed the position of Di-
rector of Merchandising. Prior to this appointment, Mr.
Gatto served as Director of Franchise Operations for
Sentry Drug Centers, Inc.

Douglas L. Thompson, formerly of McKesson &
Robbins Drug Company, has joined Gilpin Wholesale
Drug Company as Vice-President of Operations.

Wendell M. Norwood has been appointed Vice-
President of Sales. Prior to coming to Gilpin, Mr. Nor-
wood was National Sales Development Manager for
McKesson and Robbins Drug Company.

Upper Bay
Pharmaceutical Association

The December meeting of the Upper Bay Pharmaceu-
tical Association was held at Bush River Yacht Club on
the fifteenth of the month at 10:15 p.m.

Elections were conducted and the 1977 officers were
announced: Jonas J. Yousem, President; John W. Con-
rad, Jr., Ist Vice President; James L. Ter Borg, 2nd Vice
President; Charles V. Bernard, Secretary; and Barbara
C. Barron, Treasurer. The Executive Committee con-
sists of Don L. Bradenbaugh of Harford County, and
David H. Ayres of Cecil County.

The guest speaker was Walter Donnellon, Chief of
Labor Relations for Procter & Gamble. Mr. Donnellon
discussed his role as an arbitrator in industrial relations
and the applicability of this role to the many problems
facing pharmacy today.

A-200 PYRINATE KILLS'EM DEAD.

MPhA TRAVEL
BULLETIN

Crabs, head and body lice, nits —the
only medicine anyone needs to stop them
dead is A-200 Pyrinate, the No. 1 lice
killer. It has the highest turnover rate of

SKI VAIL,
COLORADO

March 5-13, 1977

any pediculicide.

$359.00 per person
per double occupancy

A-200 Pyninate.

Special Rates for Children under 12

At $2.29 suggested retail, A-200
Pryinate means excellent profit for you.
And it’s non-prescription, which means
good walk-in business. It’s advertised in
college and underground papers. And this
year, the Lice Alert Hotline Program will
make people more aware than ever of

Stock both forms of A-200 Pyrinate.
The Liquid is ideal for head lice. The Gel
is convenient for children,
and for treatment of crab

Why bother stocking anything else?

is the Pharmacists’ Pediculicide. It’s the
only lice remedy you need to stock. Dis-
play it in the medicated shampoo section
for impulse purchase, and behind the
counter for your own recommendation.
LICE ALERT HOTLINE: When
lice strike, call us toll free at 800-431-1140.
Once the outbreak is verified, we'll
swing into action with a whole prograrr
designed to stop an outbreak before it
gets rolling. And to thank you for your .
quick thinking, we'll send
youa gift you can use in ewe
your professional OO:
practice.

Trip includes round trip via
United Airlines Charter
8 days and 7 nights
at the HOLIDAY INN.

Limited Space!
Contact Ronald Lubman
(366-1744 or 486-6444)

or
MPhA office (727-0746).

lice in the pubic and
hard-to-reach pen-
anal areas.

A-200 Pyrinate

Lad 1
Lice Medicine

P Crab Louse (Phthirus pubis)

© 1976, Norcliff Thayer Inc.

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compete for the custom- AYE,
ers dollars, at your phar-Ve> Vs
macy. So, when it comes time

A lot of fine pou

to stock your shelves, THE
MARYLAND NEWS DISTRIBUTING

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\
COMPANY is well aware of your needs. iM ie

Our product is periodicals — magazines
and paperback books — and we continually
supply your racks with a variety of current
reading material appealing to every taste and
keeping your customer reader interest at its
highest.

We understand that turnover is important.
With periodicals you have a sufficient new
product each month to stimulate traffic not
only for our product, but for a// the products
in your store.

An investment of $100 in periodicals,
normally will result in $127 of sales within 30

DECEMBER, 1976

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cS copies of our product are return-
able for credit, there is absolutely
ep no risk.
But perhaps the most important fact
is that periodicals have an unselfish way of
helping to sell every other product in your
store. Take a look at the pages of our maga-
zines and see how they showcase just about
every other product that you sell over and
over again. It is like having a built-in
salesman.
To learn how you can really “help your-
shelf,” why not give us a Call;
The Maryland News Distributing Co.

(301) 233-4545
Ask about periodicals, the unselfish product.

ANNOUNCING:

THE NEW
“RETURNED GOODS"
POLICY FROM
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In our continuing effort to help make your This liberal “Returned Goods” Policy

use of our pharmaceuticals more convenient: means you deal directly with the
@ B.W. Co. now accepts the direct return Company, not with your wholesale
of all B.W. Co. products, regardless of distributor.

date of manufacture

For full details, please contact your
e B.W. Co. now accepts open bottles with P y

partial contents for exchange B.W. Co. Representative or write:

e B.W. Co. now replaces returned goods Burroughs Wellcome Co., Claims and
with an ole a Se ao nt of B.W. Co. Adjustments Department, Box 1887,
high volume merchandise of .

Poraseecian Greenville, N.C. 27834.

@ B.W. Co. now reimburses you with Burroughs Wellcome Co.
additional products for all postage nas Research Triangle Park
costs incurred Wellcome | North Carolina 27709

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